Healthcare Payer Services
Claims Fraud & Abuse
The size of the health care sector and the enormous volume of money involved make it an attractive fraud target. Therefore, effective fraud detection is important for reducing the cost of health care services. HTC's solution proactively identifies potentially fraudulent claims through the use of proven techniques and isolates them for further investigations and inquiries.
Cost Trend Analysis
Advancements in medicine and technology have lengthened the lives of Americans, but they do not come without a cost. Rising health care costs raise health insurance premiums and also make it more difficult to purchase insurance policies which contribute to the rise in the number of uninsured. At HTC we predict cost trend analysis where we take claim invoice amount from the providers for the past years as input and output is the forecasts for future months.
Enterprise Data Hubs
A common challenge among most of the payer organizations is the lack of a centralized data repository to consolidate data from different systems with different formats of data from multiple upstream functional areas. Reporting cycles and dashboards can also be delayed, in turn impacting critical business decision making. HTC has addressed this challenge by developing the -Enterprise Data Hubs- model, which will seamlessly consolidate data from disparate systems, reduce reporting cycle times and enable effective information exchange across the organization and beyond.
Many a times when the cost shifts to the patient's responsibility, providers find it difficult in determining the patient amounts. Provider Payment Estimator can help providers to reduce the administrative costs and save time by offering providers more self-service functionality in determining patient coverage. HTC's Provider Payment Estimator is an extremely intelligent online tool that enables providers determines patient eligibility and a more accurate estimate of the patient responsibility amount, prior to rendering the medical service.
There are a large number of providers offering Health Savings Accounts but the biggest question that remains as a mystery is how much? to invest on Health Savings Account. Understanding this need, HTC's HSA estimator tool will educate your members on the cost of each healthcare service they plan to obtain, to enable making well informed decisions on the amount to be allocated for each health need.
Deliver Healthcare Value, Control Costs, and Improve Operational Efficiency with HTC’s Healthcare Offerings
- The US healthcare reform is bringing in tremendous transformation by empowering millions of people with easily accessible and affordable healthcare services