Payers

Healthcare Reform will reshape the healthcare industry and service providers. Payers and providers face mandated technology investment, while facing increasing costs pressures, oversight and expanded membership.

With our over two decades of healthcare payer experience, Acurus is focused on improving the interoperability of payer systems to improve communication, increase revenue and reduce cost by providing technology/business processing outsourcing solutions and analytics to help payers meet the new challenges.

We offer best-in-class services for healthcare payer clients:

  • Claims Processing
  • Claims Adjudication Services
  • Member and Provider Contact Center Solutions
  • Mailroom Services

We use LEAN and Six Sigma methodologies to simplify existing business processes by cutting down inefficiencies.

Our superior healthcare business solutions, with insight-building analytical expertise, offer your company an unmatched focus on quality of healthcare delivery, productivity, and customer experience.

Payers > Patient Data Management

Patient clinical data from disparate sources - multiple EHR, Hospital Systems, Lab..., combined to provide consolidated view.

  • Maintain Master Patient Index
  • Integrate clinical data from disparate sources - Various EHRs, Labs, Diagnostic Imaging Centers, Hospital Discharge Data
  • Identify and report NCQA HEDIS measures
  • Identify and report PQRS measures
  • Identify HCC Codes
  • Calculate RAF Scores for every member

Payers > HCC Coding Service

Our goal is to help physicians document all the diseases for Medicare Audit compliance, which will result in the appropriate RAF score for each patient. This will in turn improve your CMS 5 Star/HEDIS measures

  • Provide feedback to physicians with custom physician training
  • Capella-Wish software is, specially designed for HCC coding compliant and Wellness Center Support
  • Chart review by Certified Coders - AHIMA or AAPC
  • Review your patient charts Claims (electronic or paper), Lab and Prescription data and identify all of the RAF & Non-RAF related ICD-9-CM and/or ICD-10 codes and any 5 Star/HEDIS measures
  • Review the claims data and identify the gaps between the codes in the patient chart and claims data
  • Review charts for Documentation Standards, MEAT and CCI edits Identify documentation deficiencies for provider feedback /training
  • Create a specific library of patient charts for you to access and monitor electronically
  • Scan paper charts at the physician practice if needed. We can obtain charts directly from the physician office or work with those charts provided by the health plans

Payers > Data Analytics

Health informatics develops innovative ways to put information and knowledge to use in promoting health and improving health care while reducing costs. Focusing on informational, computational, behavioral, and organizational sciences, along with deep understanding of health systems and processes:

  • Identify high risk patient to proactively provide care
  • Calculate B/A Ratio
  • Identify Cost - per member per month (PMPM)
  • Provide Total expenditures per member
  • Population Management
  • RAF Scores for each patient
  • LACE scores for hospital admits
  • Quality Measures - Report, Analyze and recommendations
  • Correlation model to link LACE, RAF and Healthcare Expenditure
  • Correlation model to link Co-morbidity conditions and Healthcare expenditure

Payers > IT Support

Acurus IT Support and Solutions allows your organization to focus on your core business. From Application performance management, application development to managed IT service, Acurus can support you 24 x 7.

IT analytics specializes in information technology solutions for the healthcare industry. Our extensive experience focuses on clarifying business problems that require technological solutions. Our expertise includes system architecture, analysis of components (buy vs. build) and full integration of existing technology, third party solutions and custom applications.

Payers > Application Development and Support

Staying on top of application performance and availability is critical to proactively head off application problems before they happen. Deep, proactive application monitoring, reporting, and alerting keep you in control of your service delivery. We will monitor application performance along with the critical parts of application delivery, including servers, services, and the network. We offer cost effective interface solution to interface multiple EHR systems to facilitate data sharing between Hospitals, Physicians and Wellness Centers.

Acurus IT Support and Solutions allows your organization to focus on your core business. From Application performance management, application development to managed IT service, Acurus can support you 24 x 7.

IT analytics specializes in information technology solutions for the healthcare industry. Our extensive experience focuses on clarifying business problems that require technological solutions. Our expertise includes system architecture, analysis of components (buy vs. build) and full integration of existing technology, third party solutions and custom applications.

Health informatics develops innovative ways to put information and knowledge to use in promoting health and improving health care. Acurus with a core competency in health informatics provides significant expertise of informational, computational, behavioral, and organizational sciences, along with deep understanding of health systems and processes.

We support users across the healthcare system by streamlining management and analysis of clinical patient data generated by diagnostic imaging systems, cardiac testing equipment and patient monitors. We support the continuum of care through an effective suite of solutions for enhancing clinician workflow and patient care, while interfacing seamlessly with core hospital information systems.

The national healthcare reform will reshape the healthcare industry and service providers. Payers and providers face increasing cost pressures, challenges created by increased oversight, mandated technology investment and increased operational processes caused by increased membership.

With our over two decades of healthcare payer experience, Acurus is focused on improving the interoperability of payer systems to improve communication, increase revenue and reduce cost by providing technology and business processing outsourcing solutions and analytics to help payers meet the new challenges.