As a TPA, you would make the right selection in choosing a competent, process oriented and most important a security focused business partner. A perfect partner would help you bring efficiencies on the claims management business process while reducing the cost to grow your business. That's why VeeInsure will be an ideal choice for outsourcing your work in India. VeeInsure guarantees high (98+ %) accuracy with assured turn around time allotted in HIPAA secured environment.
VeeInsure has rightfully earned a niche as the Top 5 emerging major Global services provider, a secure feeling our clients take refuge in and proclaim Vee as the best choice for their end-to-end processes. Vee has excellent domain knowledge in complete back office processes for TPAs and thus providing absolute solution for all of their problems and challenges.
Domain Knowledge on TPA
VeeInsure is offering end-to-end services to its TPA clientele with its high end domain knowledge and experience of handling the TPA services. The following are the few of the niche services.
Vee started its TPA processing operations in 2003, processing rule-based HCFA 1500 Insurance claims soon to expand to UB92, Dental, Vision, Prescription (RX) and Super Bills processing. All of these rules based processes demand a domain knowledge expertise of the Healthcare services as applicable and prescribed for US Healthcare environment. VeeInsure has a meticulously designed training programme that carries through a 5 step process of systematic training on the different versions of ADA Dental forms and rule based insurance forms processing.
2. PPO Repricing/Discounting
Outsource this manual labor intensive PPO Repricing process to VeeInsure!
VeeInsure offers several options for your repricing needs:
VeeInsure can manually reprice these claims for you. Whether your repricing department uses the PPO's web-site, custom application or spreadsheet fee schedules supplied by the PPO.
VeeInsure can verify reasons of kickout claims from auto repriced system and update the changes as per requirements for reprice claim.
VeeInsure can route claims that originated as paper forms or electronic claims to the appropriate PPO. The PPO reprices the claim and either sends the claim directly to the payer or back to VeeInsure for further processing.
3. Provider Maintenance / Credentialing
VeeInsure has expertise to maintain TPAs Provider database by adding new provider or modifying existing information every day based on TPAs comments. These changes or additions will take place by accessing TPAs RIMS server or COMPASS server or any other client server connecting through VPN or Internet. VeeInsure also specializes in Provider Credentialing.
4. Flexible Spending Account (FSA)
VeeInsure maintains the enrollee Flexible Spending Account (FSA) information. The following information is maintained for a flex type, group, and enrollee for the current or prior flex year: Contributions, Expenses, Payments, Available Contributions, Enrollee comments.
5. Correspondences
When the claims get pended due to insufficient information for claims payment, lot of correspondence in form of attachments, letters, etc. are transferred between the TPA and the Enrollee. This process is called as Pends/Correspondence Indexing. With VeeInsure handling the Pends Process the duration for Pended claims payment has improved.
6. Flex Re-enrollment
VeeInsure handles the Flex Re-enrollment Process for TPAs during the annual flex re-enrollment period. This process includes updating the employee, dependents information along with the coverage details.
7. Employee Address Maintenance
VeeInsure maintains the demographic details of all the Employees of the TPA's clients. These details are maintained by accessing the TPA's RIMS/Compass server. When the TPA despatches the EOBs or Intimation Cards to its clients the USPS sends back address cards for which there were unsuccessful despatches. VeeInsure Updates the Employee Addresses for all the returned mails.
8. EDI - to - Image Conversion
Claim processors and auditors know that it is very difficult adjudicate an EDI claim as they are a bunch of numbers. VeeInsure has custom built software which converts an EDI (837) or ECSIF (Electronic Claims Submission Input Format) into a HCFA/UB image. This image is then fed to our adjudicators who can better visualize and relate to the claim better. This process improved the accuracy of claims payment by over 5%.
9. Indexing
The TPA sends all the Faxes and W9's for indexing and creating a database. VeeInsure indexes and then uploads to alchemy (marrying the data and the image) database for TPA to retrieve the W9 or the Faxes whenever needed.
10. Pre-Certs
VeeInsure handles the Pre-Certifications (Pre-Certs) work for the TPA by adding required information like ICD9 codes, Date of Service, Number of Certified days and provider information into RIMS. VeeInsure also handles the Referrals.
11. Case Management
VeeInsure manages cases where critical information needs to be loaded in to the RIMS. TPA sends Vee the list of cases on a daily basis. Vee Case Management Specialists access into the ENF screen of RIMS to input specific data related to some of the cases notified.
