Payer Portal

This is a one-stop solution for all-payer requirements. It has configurable workflows that enable the users to easily manage end-to-end workflows, starting from enrollment to claims payment, collecting & viewing member benefits, and claiming history on their fingertips using a mobile app and web portal. It connects all the parties on one unified platform, which makes claim processing faster & easier. It also offers a seamless view of claim status to members, providers & payers. Additionally, the complete suite provides independent modules like credentialing, Grievances and Appeal (G & A), Utilization Management (UM) & Business Intelligence tools that seamlessly integrate with other legacy applications.

Key Features
  • Built-in contracts management and rule engine for a faster claim’s adjudication process
  • Collaborative portal to bring stakeholders for communication and tracking of claims
  • EDI integration (e.g., 835, 837) for electronic transfer of data according to regulatory guidelines
  • Workflows to manage the entire lifecycle of claims origination to payments
  • Notifications for updates and pending actions for claims
  • Advanced analytics and reporting for claims history, payment history
Technology used
  • .Net, MSSQL, Tableau, HTML, JS, AJAX, bootstrap
  • Cloud Hosting – Azure & AWS
  • Centralized record management and claims adjudication process
  • Streamline processes to speed up payments through workflows and analytics

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