HGS provides a broad array of claims management and member lifecycle services for this client, including international claims service to process healthcare claims filed abroad by client members. This site processes claims from 90 countries. HGS has supported a key client objective of a turnaround time service level expectation of processing 98% of claims in 10 days. To ensure this success, HGS deploys expertise at every stage of the lifecycle. HGS works with the client’s premium collection and eligibility platform. This claims adjudication system and client/server application is used for the client’s end-to-end operations.
We use this application for all the following functional attributes toward claims adjudication:
- Authorization – Pre-authorizations of medical services
- Claims – Claims adjudication
- EDI Claims – Electronic claims adjudications system
- Letters – Correspondence system to send letters for members and providers
- Benefits – Plan benefits coding and updates
- Members – Subscriber master database
- Premium – Premium records and database
- Pricing – Pricing logic and contracts
- Providers – Provider master database
- Reports – In-built reporting system
- Security – Security systems for personal health identification (PHI) / national provider identifier (NPI)
- Support – Customer support
- Systems – System records and updates
HGS’s team continues to build on the expanding portfolio of solutions built for the client, with intelligent automation and analytics solutions identified for the client’s premium collections, member enrollment, and eligibility groups.