Claims Services

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Claims Services

Automate and Simplify Your Claims Management

Reduce errors, increase accuracy, simplify your operations and accelerate your claims process with our comprehensive catalog of claims services.

Each year hundreds of billions of dollars are lost as a result of claims related deficiencies. Health plans struggle with claims accuracy, broken processes and waste leading to significant losses in revenues and damage their customer satisfaction and Stars ratings. Keeping up with technology advances and finding the best options for managing core administration functions in an increasingly-complex market have proven difficult for many plans and as these plans grow, these issues only grow with them. Increasing demands from new members and providers, the push to reduce operating costs and better utilize data to improve member experience and outcomes puts pressure on claims operations and processing. To optimize claims operations, plans need fast, flexible solutions that improve accuracy and decrease operational loads.

Complete Claims Management

Advantasure has designed a suite of services and technology platforms that can significantly improve your ability to manage the claims process. Backed by industry expertise and proven programs, our claims services are specifically created to accurately and efficiently manage the execution of claims processing on your behalf. Our proprietary claims technology platform is built for government healthcare plans. This same technology powers our full-service solution. Streamline your claims processing and management with our experienced team and integrated systems that deliver a complete claims solution.

Service Capabilities

  • Robust claims processing solution that delivers high adjudication rates
  • Flexible, automated highly configurable rules engine fuels efficient claims processing in accordance with CMS guidelines
  • Coding solutions, both industry standards and efficient customized coding to enhance claims processing
  • Weekly generation of claims payment processes
  • An overall claims solution that reduces appeals and realized medical and administrative savings
  • Monthly monitoring to ensure claims are processed timely and accurately
  • Oversee the aging and timely payment of claims
  • Ensure provider payments, remittance advice and member explanation of benefits are correct and timely
  • Maintain workflows, policies and procedures and desk level procedures for claims

Client Performance Results

  • Nearly 50% reduction in total operating costs, on average
  • Achieved a 95% auto-adjudication rate

We’re here to help

Plans turn to Advantasure to help achieve their business objectives with technology platforms and full-service options. Our claims management service has proven to be an effective solution for plans that are struggling with, or looking to improve, their back-end operations. Our team, with deep experience in regulatory, plan, technology, government agency and other fields, knows what it takes to be successful in all areas of managed health plans including core enrollment, claims, billing operations, quality and risk. We understand the complex nature of your business and want to help your plan succeed. Streamline your operations and reduce administrative burdens with Advantasure’s full-service solutions.

Let’s connect and talk more about how Advantasure can help your plan fuel success.

Find Out How We Can Help You Drive Forward

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