TRANSFORMATION THROUGH DIGITIZATION & AUTOMATION

Improving health claims processes has a significant impact on the business of insurers. Efficient claims management helps insurers improve customer experience, reduce processing costs & time, adjudication errors, and increase regulatory compliance.

NAlliancetech Business Process Management (BPM) solution for healthcare helps insurers and payers transform their claims management processes. Its insurance clients have reaped significant benefits in terms of cost, speed, and accuracy by using TruBot, an enterprise grade multi-skilled robotic process automation (RPA) bot. NAlliancetech uses advanced imaging technologies, document capture, proprietary intelligent document processing solution, TruCap+, and rule-based algorithms to mine context and intelligence from unstructured data. This helps insurers minimize adjudication errors, reduce claims processing costs, increase efficiency, and deliver a superior customer service experience.

NAlliancetech BPM solution for healthcare enables enterprises to take full control and cognizance of monitoring and eliminating fraud in the claims processing. It engages Artificial Intelligence (AI) / Machine Learning (ML) algorithms and reduces instances of false positives and false negatives while improving the processing time and turnaround time.

ADVANTAGES

30+

Years of Experience

Expertise in delivering intelligent solutions for the healthcare and insurance enterprises in both international and domestic markets

25 Million

Claims Processed Annually

Delivered automation projects using point solutions as well as end to end automation models across geographical barriers

100 Million

Images Processed Annually

Precision deliveries to ensure statutory compliance in a timely manner

Audit trails with high visibility and traceability

HEALTHCARE PROCESS
MANAGEMENT OFFERINGS

PAYER SERVICES

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Mailroom & Scanning

Engages intelligent document processing and RPA to expedite scanning and processing of paper-based forms

Provides exceptional processing speed and accuracy catering to all payer requirements

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Claims Management

Offers claims registration, claims verification, claims settlement & disbursement, fraudulent claims management and audit of claims management

Accelerates claim settlement procedures

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Claims Pre-Adjudication

Adjudicate claims forms with minimal errors. and high levels of accuracy

Reduce instances of false positives and false negatives with AI / ML algorithms

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Adjudication Services

Facilitates faster settlements and lowers healthcare costs per claim

Ensures cost reductions in data processing and ensured savings year on year

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Member and Provider Matching

Ensures accuracy in payments processing

Facilitates direct payment to account

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Sales & Underwriting

Offers effective contract management, sales automation, quote and rate underwriting, risk classification, and pricing solutions
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E-Portal

Offers interactive web portals to enhance member-provider engagement and interaction

Offers a digital ecosystem to expedite claim processing and settlement

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Membership Management and Billing

Ensures complete automation of the data management system to facilitate new membership enrollment, renewals, eligibility checks, monitoring, and client billing
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Care Management

Presents user friendly, Omni-channel care management that helps payers provide on-demand support to patients

PROVIDER SERVICES

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Revenue Cycle Management Services

Facilitates a seamless transition from the traditional ‘‘Fee for Service (FSS)’ payment model to a more integrated ‘Pay for Performance’ model, with automated coding and insurance verification
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Payment Posting Services

Covers posting of payments received from Health insurance payers / members towards settlement of claims to relevant patient accounts

CRM SERVICES

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Customer Information

Maintains updated records of patient information and related contact details

Facilitates updating of interactions in the patient, payer, and provider ecosystem

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IVR Solutions

Offers all patient communication on a single platform; automates the hospital’s precision care workflows and guides the patient with real-time data access.
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Enterprise

Provides services and software for quality management, regulatory compliance, and F&A management

Offers auditable and enterprise grade solutions

Frequently Asked Questions

Enterprise Portals offer role-based access to authorised employees to the different enterprise assets – content, data, and business applications. It is a safe and secure platform for knowledge management, knowledge transfer, and collaboration.

API Management involves developing and publishing application programming interfaces or APIs, controlling their access, tapping and analysing application usage statistics, and generating reports for performance management.

APIs are used to make application architecture more composable and integrable with other applications. API management is a best practice in the overall application lifecycle. It allows improving the abstraction levels of an application to offer improved integration and a strategic edge.

APIs and API management, in general, allow businesses to modernize their existing IT application landscape and offer seamless user experience, such as secure single sign-on and integrating commercial-off-the-shelf products in agile and resilient enterprise architecture.

Business requirements change from time to time and not all commercial off-the-shelf products from different OEMs offer a complete solution to business requirements. System Integrators address the business requirement to provide a complete solution. They are aware of the pros and cons of products available in the market and can tailor solutions while trying to eliminate technical debt. They help businesses to consider a wide variety of software options available and shortlist the best ones for an upgrade. However, it has to be noted that the existing investments and customizations should be easily reusable in the new environment. Maintaining continuity with a selective pick and choose between existing environment pros and the new options available in the market is a best practice. The customizations in the new environment should be over the top so that they can be easily carried forward to the next big upgrade.

For example: Migrating the SAP BO environment to MS Power BI looks like a mighty leap away from the closed SAP architecture. However, SAP BO’s current versions have limited capabilities for DIY reporting and Cloud leverage. Hence migrating to MS Power BI, which provides the limitless capability for self-service reporting sans dependency on huge IT developer teams, makes perfect business sense till SAP rolls out its agile yet rugged reporting feature that can be leveraged over the Cloud. Besides MS Power BI has the capability to reuse and accommodate the existing universes and customized semantic layers, dashboards, and reports from the As-Is environment to the To-Be environment over the Cloud.

24×7 L1, L2, L3 support is an ideal scenario in Application Management. However, the customer business has to judiciously select the preferred Application Management and Support model that suits their business requirement and budget. Businesses can opt for 8×5 and 16×5 models within the ambits of predefined SLAs and turnaround time.

Amit Mahajan
N Alliance Tech Commercial Director

Our mission is to help your business grow through remote development talent. Reach out with any questions you have and follow us on social media to see the life of N Alliatians.

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