Healthcare Payer services

Mailroom Operations

• Our team of specialists provide round the clock support in handling mail room operations such as sorting, scanning, indexing and allied data capture activities

Claims Indexing

• We provide indexing & invoicing service for third party administrators (TPA) in the USA.
• The scanned claim related documents are quickly indexed / triaged and routed to the adjuster to manage them consequently.

Medical Bill Review

• Our teams of specialists enter the drug or service details, quantity of the medicine, provider details & CPT code in in the client’s review software for bill review process.
• We help clients manage the cost of claims and facilitate online access for adjusters to view and release audited medical bills prior to finalization.

Utilization review

• The utilization review process helps employers, insurers and claims administrators to review medical treatments to determine what is medically necessary.
• Determination of medical treatment will be made according to the relevant authorities or with other evidence-based medical guidelines.

Bank Reconciliation

• We compare and match figures between the client’s bank statement (supplied by the bank) with the corresponding amount shown in the client’s own accounting records at a particular point in time.
• Any transactions in the accounting records not found on the bank statement or vice-versa are validated and accounted for. We maintain the client’s accounting records and perform reconciliations in systems such as Great Plains, Imprest system and CC Systems.
• We Handle over 200+ accounts, generating bank statements from various multi-national banks

Workers Compensation

Invoice & Claim Processing

• We receive claim invoices and validate if all the fields are filled in and with necessary approval
• We key the necessary entries into client application
• We also validate the keyed entries with the copy of invoice and process the invoice into the client application

Policy Renewals

• We obtain proof of timely renewal payment from the brokers and apply the payment against policies through the appropriate platform
• We validate the policy to identify payments received prior to the due date
• For payments past the due date we work with onshore team to apply the money appropriately following due protocols

Payments and denials

• We analyze claims based on defined standards and approve/deny the claim payments
• We file the mandatory C8.1b and C8.4 forms with the Workers Compensation Board

Analysis & Reporting

• We create various analytical reports such as Overdue report, MVLE fee Report, Beep Reports and Cancellation Reports as needed by the client

Commercial Auto Liability

No Fault Insurance

• Pride supports the No Fault Insurance department by preparing EOB (Explanation OF Benefits) reports, creating PIP (Personal Injury Protection) Payout sheets, and providing services for Verification Request Documentation and Denial Documentation for ‘no fault’ claims.
• We also provide assistance for IME (Independent Medical Examination) by creating Scheduling Letters and coordinating the IME Peer Review & AAA Case Initiation Documentation for the No fault Insurance department.

Financial Reporting & Analytics

• In addition to budgeting support and insurance reconciliation, we assist you in preparing your Quarterly Financials and Tax Returns.