Health Plan Solutions Sutherland Healthcare Solutions
Achieving your TRUE RETURN requires flexible, rusults-oriented business processes.
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That’s why Apollo Health Street works with the nation’s leading health plans, provider network organizations, and third party administrators to create customizable, efficient solutions for their operations. The results are lower costs, improved member and provider satisfaction, and the necessary flexibility to change with market and regulatory conditions. Our proprietary technology tools and Six Sigma based methodologies combined with a global delivery model help deliver outstanding results to our health plan clients.
Our deep clinical domain offers unparalleled resources and experience Six Sigma methodologies facilitate measurable process improvement, beyond conventional limits Blended shore delivery offers lower cost without sacrificing quality Compliance program strictly adheres to HIPAA and other healthcare information regulations ISO:9001 certification ensures strict quality management standards in our daily operations Advanced, intelligent software ensures a strong return on investment End-to-end business outsourcing solutions span the healthcare market
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Provider Data Management Provider Contract Management Apollo manages all types of network affiliation changes, fee schedule maintenance, and other contracting term maintenance for physicians, hospitals, and ancillary providers.
Complex contract and pricing term maintenance Demographic maintenance for all provider types Network integration (merging PPO networks) and implementation of Single Record of Truth Improved quality results in accurate claims payment and improved accuracy of provider directory information
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Provider Data Cleansing and Verification (DCAV) Services Recognizing the importance of accurate provider information and the challenges in maintaining up-to-date information, Apollo’s DCAV team utilizes a variety of tools to identify and correct crucial information.
Web-based data searches Database comparisons Calling campaigns to reach out to providers directly, collecting and verifying information Propriety tools that assure the best possible productivity including the collection of valid addresses Stringent QA analysis that assures the highest quality output
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Claims Administration Provider Matching Claims that fall out of the automated matching process can cause a significant bottleneck within claims re-pricing. We accurately match these claims according to customer business rules and return them in a timely manner so that overall claims turnaround times can be maintained.
Understanding of provider contracts and network configurations Tailored services to meet customer needs Meet strict turn-around-time requirement of four hours, six days a week Management of unpredictable volume levels that fluctuate hour-to-hour and day-to-day High levels of accuracy (>99%)
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Claims Adjudication Apollo’s claims adjudication team has significant experience in claims administration with our senior team members bringing more than 20 years of knowledge. The Apollo team processes millions of claims every month.
Meeting high-volume needs with financial accuracy and turnaround times of 12 hours or less Offering a variety of methods including via customer systems, web-based tools, or internal applications Handling of specific and aggregate stop-loss claims and managing split retentions, aggregating specifics, and complex catastrophic claims Reducing claims errors using root-cause analysis, providing valuable feedback along with accuracy ratings Managing the most complex COB and subrogation claims, with timely follow-up for those requiring long-term status reviews and updates
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Front End Data Capture Services
Apollo provides full mailroom services from our state-of-the-art fully secure onshore facility. Our document preparation and scanning services include both standard and non-standard forms, including RX receipts that require special handling. Using Onbase imaging, Apollo professionals capture customer specific data elements from scanned images and assign indexes which allow prompt and efficient image retrieval.
Access to fully secure mailroom services, including data capture of incoming mail Accurate, high-speed scanning of paper files which is manually audited Efficient and secure image storage and retrieval Ability to process over 800 different file formats
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Customer Services
Apollo’s award-winning customer service is the right solution for healthcare organizations looking for a personal touch and efficient operation through call center interactions.
Global resources to efficiently administer customer service, with 24/7 availability Voice professionals with rigorous and ongoing training Customized staffing models that provide the required Average Speed to Answer (ASA) Continual monitoring of abandonment rate to maintain the required service level
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Network Management Provider Recruitment Services Provider Recruitment is time consuming and requires extensive follow-up efforts. Apollo maximizes the success of recruitment programs using highly-qualified professionals who can communicate efficiently and effectively with all types of providers, explaining contract terms and overcoming objections.
Proprietary web application to streamline provider recruitment process Management visibility to status of each provider through the entire life cycle of recruitment Analysis of providers’ reasons to decline network membership Assistance with health plan and PPO strategies to improve recruitment results Smooth integration of Apollo’s call based recruitment efforts with client’s on-site recruitment efforts
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Credentials Verification Organization (CVO) Apollo’s CVO collects, compiles, and verifies primary source verification required within the credentialing process. Our proprietary software enables efficient management of the credentialing process leading to high quality, quick turn-around times and increased productivity.
Streamlined credentialing process Adherence to customer-specific business rules to accommodate any special credentialing needs NCQA and URAC guideline adherence Smooth integration of Apollo’s proprietary software with your credentialing application
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Eligibility Maintenance
Apollo’s eligibility specialists follow customer-specific business rules to maintain accurate eligibility data tailored to any turnaround time requirements. Mass or individual updates are completed from images or spreadsheet formats, with image storage and retrieval capabilities.
Population of census information into underwriting tables, leading to increased underwriting efficiency Prompt and accurate generation of policies and identification cards within customer-specific timelines
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Plan Maintenance
Apollo professionals are experts at plan building and maintenance on a variety of applications and can meet stringent accuracy and turnaround time requirements. Our team can handle benefit designs by benefit code, revenue code, CPT, ICD9/ICD10, or other customized methodologies.
Customized plan building and maintenance by experienced professionals using virtually any methodology Creation and ongoing maintenance of rate tables, cost breakouts, and tracking Billing statements provided with complete premium collection and reconciliations
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Contact Us TODAY To Learn More Website
www.sutherlandglobal.com
SGS.Healthcare@sutherlandglobal.com
Phone
+1-800-388-4557
Explore Sutherland
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