Our Client was founded over 12 years ago with the intention of improving the health of senior members by providing access to high quality, cost effective health care.
It is a community-based local network, providing coordinated care to members in small to medium-sized communities across the United States. They offer a variety of value-oriented Medicare Advantage health plans, and exercise the utmost standards of dignity, compassion, understanding and respect for their members. They have a member base of approximately 65,000.
Client’s Pain Points
- The Client was a new start up and wanted to market its plan aggressively to the Rural Segment
- It had an ambitious business plan of increasing its membership base from 20K to 75K over a period of 3 years. For this they wanted to focus their attention on marketing activities rather than day to day operations
- It faced with issues on Quality, TAT, Training and coordination with its earlier vendor
- e4e’s rich talent pool and extensive experience in various claims processing software (such as Velocity, Diamond, Power MHS, Prime Meridian) made it easier to process clean claims in a much shorter time frame
- Average clean claim processing time was brought down from 30 days to 10 days
- The overall quality level improved from 96% to 98%
- The Client has been able to negotiate better rates with Hospitals and Physicians and also sign up with more network providers
- With the assistance provided by e4e on claims processing, the Client has been able to concentrate and improve its TAT on complex claims and save numerous dollars
- Clean Claims End-to-End Processing – 8 Days
- Quality: Overall accuracy - 98%
- Financial accuracy - 99%
- Procedural accuracy - 97%
- Enrollment Entry & Audit - Within 24 hours