Claims Management

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.


Meaningful Use certified Capella EHR has been designed by physicians, for physicians – customizable for each physician within your group.

  • Automatic identification of duplicate patients
  • Intuitive appointment scheduling
  • Longitudinal patient records
  • Frequently Used List – Dramatically reduces typing by the user! – Easily updatable by the Physician
  • Built in decision tools to help Physicians record chronic conditions during Assessment
  • Customized Flow to Lab, Diagnostic Clinic, Specialists etc based on the payers and much more!
  • CPOE - Lab, Diagnostic Imaging Orders submission, E-Prescription
  • Ticklers for Follow up Care – Chronic Disease Management
  • Patient Portal
click here
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
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
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:

  • 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