Sector Solutions

Case Studies
  • Overview
  • Payer Solutions
  • Provider Solutions
  • Increasing competitive advantage for healthcare payers and providers

    The US healthcare industry has seen significant regulatory overhaul in recent years which have presented new challenges for provider and payer organisations as they navigate changes in costs, care, patient experience and coverage. The expansion of coverage has added an additional 30-40 million previously uninsured people to the market.

    Firstsource work with clients in this market to help them improve their processes and meet the needs of the increasing number of patients, while improving the customer experience.

    Our “right-shoring” model and our partnerships with leading healthcare software systems AdminisTEP and Monument Systems™ enables clients to seamlessly migrate from a B2B to a B2C delivery model while managing increasing numbers of customers.

    Over two decades, we have processed hundreds of millions of claims for some of the leading US healthcare payers, third-party administrators and provider-based health plans. Our work has been recognised through several award wins, including the IQPC Healthcare Six Sigma Best Practise Award.

    Payer solutions to decrease risk and improve customer care

    As a leading provider of process-based services to healthcare payers, providing excellent customer management remains at the heart of our approach.

    We focus on creating cost-effective staffing and business process management solutions that apply advanced technology to core business functions. Our strategic approach means we continuously achieve greater return on investments while decreasing risk.

    With industry-leading technology, proprietary systems and processes, secure centralized data management and highly trained and experienced staff, Firstsource offers the solutions to establish end-to-end operations, optimise existing processes and provide our own assistance and expertise for claims processing that help our clients thrive.

    Firstsource’s dedicated professionals, high-speed/high-volume technology and best-practice automated processes allow us to manage more than 1.5million documents per month, all within a comprehensive compliance framework for privacy and data protection. Through proprietary systems and deep domain expertise, we are able to provide industry-leading mailroom, workflow and document management solutions to our payer clients, so that you can do what you do best: provide excellent service to your members.

    As healthcare payers navigate the changed industry landscape reflecting ACA-related reforms, demand for member enrolment services has increased dramatically, as has demand for solutions to manage increased billing and collections needs. Firstsource lightens those burdens by providing leading-edge solutions for enrolling and assisting members, monitoring and pursuing revenue, and managing interactions with government agencies regarding federal benefits.

    The post-ACA healthcare landscape isn’t the only landscape that has been significantly reformed in recent years. Technological advances have set a higher standard for client care, requiring that your client care methods be reformed as well. Firstsource’s combination of expert staff, technological resources and industry knowledge positions us to provide client care when, and how, the client needs and wants it. Using our omni-channel client care services, you can offer members and providers on-demand support and continuity of experience from email communication through to web-enabled face time. With our deep and broad understanding of the healthcare industry from the perspective of payer, provider and member, you can be sure that questions will be answered accurately, paperwork will be completed and filed correctly and clients at all levels will be treated in a manner that reflects the highest industry standards.

    Something as simple as improperly maintained provider data files can have devastating effects all across the healthcare payer enterprise. In this demanding and highly regulated environment, having inaccurate, incorrect or out-of-date provider data is simply not an option. Firstsource’s provider data management solutions, reference multiple and comprehensive data sources to access the most up-to-date information available, along with hands-on research and resolution of discrepancies to ensure that the data you rely on is data you can trust.

    Improving revenue lifecycle management for Providers

    Firstsource’s provider division, MedAssist, works to continuously improve revenue cycle management for healthcare providers. MedAssist offers a complete revenue cycle product suite to enhance the revenue for hospitals and improve patient experience.

    We provide eligibility, enrolment and other recovery services that help hospitals maximise reimbursement. As a result, we’ve helped millions of patients and their families gain medical coverage and financial assistance through Federal, State and hospital-funded programmes.

    US Healthcare Insurance Company
    Leading US Non-Profit Health Provider

    $1.2 million savings through Automation for US Health Insurance Carrier

    One of the largest health insurance carriers in the US identified a 250% growth potential in business between 2013 and 2015 as a result of the Affordable Care Act (ACA), which stipulated a combined out-of pocket limit in 2014 for medical and drug costs.
    The out-of-pocket limit is calculated and reconciled by a Firstsource reconciliation team. Multiple sources increase the complexity since the entire process is manual, giving room for errors. Firstsource implemented automation to avoid multiple screen navigation and automate excess and Out-of-Pocket (OOP) calculation, bringing down the transaction processing time by 25%.

    Firstsource helped in bringing cost savings through productivity gains and improving the accuracy of the entire process. The client witnessed a 27% productivity improvement leading to a $1.2mn cost saving across 3 years with additional potential of over $2mn savings via replication. Turn-around time dropped from 5 days to 2 days resulting in 250% increase in productivity!

    25,000+ data entries completed in record time for US Non-Profit Health Provider

    One of America’s leading non-profit integrated health plan providers needed help to improve recording of Social Security Numbers (SSN) and Taxpayer Identification Numbers (TIN) information of its members, to comply with the provisions of the Affordable Care Act.
    Firstsource developed an automated system called Sympraxis to enter the missing data efficiently. The process reduced time for entering the missing data and the room for errors. Once converted to the Sympraxis system for input, data entries increased significantly to an average of 5000 entries per day. The system eliminated operational inefficiencies and delivered results in quick time.

    A customized front end portal assisted in efficient data entry directly into the client database. Through the creation of this portal, Firstsource was able to deliver 60,000 files in 12 business days, ahead of schedule. This allowed for an early start on phase 2 which included 25,000+ entries completed in 7 days. All project deadlines were met in record time and Firstsource delivery exceeded client expectations.

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