Insurance Claims Processing

Premier provides right sourcing services for the entire continuum of claims processing from data entry to adjudication for health insurance companies and Third Party Administrators (TPAs). We understand that our clients have unique needs based in part on the individuality of style and services. This means, the 'one size fits all' approach will not work in their case. Therefore, we design our solutions specifically for you after studying your requirements, the processes followed by you, your clients' needs and your preferences. At Premier you are a valued, long-term client from day one. We realize that, the real quality service depends on your satisfaction with us, not our promises to you. "We implement state of the art processes and systems to process and adjudicate claims".

Our vast expertise drawn from expertise in the IT services and catering to the healthcare industry's full range of IT needs gives us the advantage in understanding the needs of healthcare providers, Payers and TPAs; We comprehend the importance of preciseness and, therefore, we have established a strategy which enables us to provide quality which is almost impossible for others to duplicate. We utilize our outsourcing capabilities to deliver top quality cost-effective service by providing a dedicated Account Manager in the US to establish a close relationship to our clients. We focus on our delivery centers in India to provide quality and cost benefits. At the same time, we understand the various challenges regarding security, quality control and delivery schedules faced in an outsourcing approach and, therefore, over the years, have perfected our processes, methodologies and infrastructure needed to overcome these challenges. Our Delivery Centers in India are streamlined and ready to increase business processes.

The main advantage of using an offshore approach is found in cost and availability of qualified data entry operators, adjudicators, coders and data processors. The 12-hour time difference between India and the US adds to India's competitive advantage. The voice data that flows in during an American work-day is processed in India (when it is night in the US) and the processed data sent back by dawn in the US.

Our HIPAA compliant solutions leverage leading Internet technologies and the world's most highly qualified data entry operators, adjudicators, coders and processors to provide easier, more secure, accurate and cost-effective services. The dawn of government regulations such as the Health Insurance Portability and Accountability Act (HIPAA) coupled with increasingly strict insurance company requirements today are forcing the need for more efficient, accurate and secure claims processing. Under HIPAA, all data entry operators, adjudicators, coders and data processors must implement technology and business processes to ensure the security and confidentiality of patient information, and establish an audit trail of all those who have accessed this information. We understand the HIPAA requirements the best because, our software services business has many HIPAA experts who have provided HIPAA Compliance services to many clients in the US.

Our Claims Processing process consists of: Entitlement, Duplicate Claims, Validity of the Claim / Fraud Detection, Extracting "Data Components" From Raw Claims, Claim Validation, Valid Claim Amount, Structured Reporting of the Entire Claims Adjudication Process and Secured Transmission of Fully Adjudicated Claim