The ever-changing regulatory environment and consumer-centric healthcare market will only increase demand for exceptional customer service over time. At the same time, payers must reduce the cost, risk and complexity of accurately and quickly processing transactions. From member enrollment in federal, individual and employer/group health plans to premium billing and exceptions management, the entire lifecycle should be timely, seamless and cost-efficient for a company to remain profitable and competitive. Managing eligibility, premium billing and reconciliation can be especially challenging as members enroll and disenroll in their plans.
Firstsource’s expert agents, leading-edge technology, and intelligent, automated solutions can take the stress out of some of the payer industry’s most crucial functions—enrolling and assisting members, monitoring and pursuing revenue, and managing interactions with government agencies regarding federal benefits, throughout the entire billing and reconciliation process—even during peak cycles.
With a myriad of different health plans available today, reconciliations never have a one-size-fits-all path or resolution. Exception reports vary, requiring greater flexibility and staff training to ensure swift responses.
Firstsource agents are specially trained and technologically equipped to manage inbound and outbound new member enrollment as well as premium reconciliation and payment calls. Our agents understand the nuances of different types of health plans and procedures, while our secure, automated data management systems enable staff to process physical and electronic forms, make plan changes, explain benefits, and answer questions for new and existing members—even after hours and on weekends. Handing more than 80 different queues, we ensure that every single exception gets a separate queue, enabling flexibility and transfer of knowledge to team members to deliver faster turnaround on inquiries and exceptions.
Reconciling payments with providers, the CMS and members can be complex, leading to delays in revenue collection. The reconciliation process must ensure cases are fully addressed and accurate payments come through to the payer on a timely basis.
Firstsource’s premium billing and reconciliation services are built around the specific needs of the payer industry to streamline revenue collection and prevent loss due to error and inefficiency. Our automated technology, centralized data management, straight-through billing capabilities, and deep industry knowledge enable us to effectively audit and analyze billing and clinical documentation to assess the accuracy of retrospective billing, reconcile reimbursements, and provide documentation enabling you to address discrepancies with minimal impact on provider relationships. Our fully integrated system can reconcile billing with revenue reports and identify potential sources of loss in the future.
Firstsource’s Medicare and Medicaid resources can help establish your company as a source of information and guidance in increasingly complex times. Our specialized agents are trained and experienced with the intricacies and specific requirements associated with federal health benefits. By screening members’ eligibility, we ensure members are receiving the coverage they need while minimizing improper payments and, when applicable, assist eligible members with a smooth conversion into the appropriate programs.
Firstsource agents are specially trained and technologically equipped to manage inbound and outbound new member enrollment as well as premium reconciliation and payment calls.
Firstsource’s premium billing and reconciliation services are built around the specific needs of the payer industry to streamline revenue collection and prevent loss due to error and inefficiency.
Our specialized agents are trained and experienced with the intricacies and specific requirements associated with federal health benefits.