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.

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
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