For Payer Side Services
At ZenniMate Healthcare, we offer a wide range of payer business process services designed to improve efficiency and reduce costs for insurance companies. Our customized solutions focus on expert claims management, ensuring processes are optimized to meet each client’s unique needs. By partnering with us, you’ll benefit from streamlined operations and improved financial performance in the payer sector. Trust our experience to help your business achieve operational excellence and cost savings.
Payer Services
- Types of Claims Supported
- Claims Data Entry Services
- Claims Adjudication Services
- Member Enrollment Services
- Provider Data Management
- Claims Pricing Services
- Appeals Processing
- Billing/Collections
- Contact Center Services
Types of Claims Supported
Our Data Services Include:
- CMS1500
- UB04 (Single / Multi / Attachment / COB)
- Dental Claims
- Foreign claims
- Medicaid/ Medicare
- Miscellaneous(complex/non-standard forms)
- Pends / Correspondence
- Prescription claims
- Superbills
- Vision Claims
Claims Data Entry Services
At ZenniMate Healthcare, we ensure precise data entry for insurance claims, adhering to all regulatory standards. We handle various claim types, including general insurance, demographic data, medical insurance (CMS 1500, UB04), and flexible spending claims. We prevent processing delays, reducing customer dissatisfaction and revenue loss. Our services offer time savings, lower costs, enhanced accuracy, and HIPAA-compliant operations. With our efficient indexing system, document retrieval is quick and seamless. Choose ZenniMate for dependable, tailored data entry solutions.
Claims Adjudication Services
At ZenniMate Healthcare, our skilled experts streamline claims adjudication by effectively managing unwanted, duplicate, and delayed claims, ultimately enhancing your profitability.
Our committed team of adjudicators, subject matter experts, and analysts takes the complexity out of claims processing, helping you navigate insurance tasks with ease.
Key Benefits:
- Skilled adjudicators with strong analytical abilities accelerate claims processing.
- Expertise in the U.S. healthcare system ensures adherence to international standards.
- Maximum efficiency, fast turnaround times, and precise record-keeping.
- Robust data security protocols ensure the safety of your information.
Comprehensive Member Enrollment Services
- ZenniMate delivers exceptional Member Enrollment Services through a dedicated team providing comprehensive back-office support.
- Our experienced professionals efficiently manage high-volume enrollments, updates, and terminations, ensuring operational smoothness.
- We work closely with clients to understand ongoing production demands and adjust staffing levels to maintain uninterrupted service.
- By integrating data from brokers and plan administrators, we improve turnaround times and ensure data accuracy.
- Our advanced workflow platforms streamline operations, perform audits, and support clients with strategic planning.
- ZenniMate efficiently handles all correspondence with members, brokers, and benefits managers.
ZenniMate’s Provider Contract Management team ensures the smooth management of provider contract terms across multiple insurance companies. We handle network affiliation changes and fee schedule updates for both physicians and ancillary providers.
Accurate Provider Data Management
Key benefits include:
- Protecting complex contract terms and pricing agreements
- Managing demographics and network integration efficiently
- Enhancing claim payment accuracy and provider directory details
- Boosting productivity, resulting in significant cost savings
- Customizing services to meet specific customer needs and tight turnaround times
- Effectively managing unpredictable workloads with high accuracy
Appeals Processing
- Healthcare payers aim to speed up and improve how they handle appeals and grievances to keep customers happy.
- ZenniMate’s technology helps make these processes better, leading to more satisfaction, higher productivity, and lower costs.
- New regulations have increased member rights, leading to more appeals and grievances.
- ZenniMate’s team reviews provider contracts to ensure quick and accurate resolutions.
Claims Pricing Services
ZenniMate ensures accurate provider reimbursement through advanced payment methodologies, supported by a comprehensive knowledge base and state-of-the-art tools.
Key Benefits:
- Efficient risk management with prospective payment solutions.
- Accurate calculation of reimbursement for inpatient, outpatient, and out-of-network claims.
- Capability to predict the effects of reimbursement strategies before they are implemented.
- Automated regulatory updates for improved compliance and efficiency.
Billing/Collections
At ZenniMate Healthcare, we provide clear and efficient billing and collection services for Medicare, Medicaid, commercial insurance plans, and PBMs. Our team of experts uses advanced technology and data management to ensure accurate and cost-effective solutions.
Our services include:
- Data Entry and Management
- Accounts Payable and Receivable
- Premium Billing
- Payment Tracking and Member Premium Reconciliation
- Plan Reconciliation
- Risk Management
- Detailed Reporting (including DOI, Cash Flow Statements, and more)
- Risk Sharing and CMS Payment Reconciliation
Choose ZenniMate for reliable billing and collection solutions tailored to your needs.
Contact Center Services
At ZenniMate, our Customer Care team stands out for several reasons:
- With years of combined experience, our experts handle customer issues and questions with ease.
- We maintain a call abandonment rate under 1%, turning every interaction into an opportunity to build brand loyalty and drive sales.
Our key services include:
- Handling claims and prior authorizations
- Verifying coverage and eligibility
- Managing member acquisition and retention
- Educating patients and providers
- Overseeing appeals and grievances
- Assisting with billing, payments, and collections
- Providing multilingual support with neutral US accents
- Monitoring calls in real-time and recording all calls
- Conducting daily audits to ensure high-quality service
Transform Your Revenue Cycle Today
Contact us now to discover how we can optimize your revenue cycle management and enhance your healthcare billing processes.
