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RP Sanjiv Goenka Group

Platform-Based Services​

Rising Star in Healthcare Payer BPaaS Services

ISG Provider LensTM
Healthcare Digital Services 2021

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BPaaS ​

Big Win in Healthcare BPaaS!

Leading health insurer selects Firstsource for large scale transformation

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Our largest Healthcare BPaaS deal

Leading Health Insurer selects Firstsource for large scale transformation

We have recently signed our largest Healthcare BPaaS deal with a leading US Health Insurer. This highly competitive, platform modernization win re-architects the client’s operations by retiring old technology and replacing it with the efficiency of a current, integrated software and service solution.

In addition to providing the latest technology, we will also take complete ownership of running their back-office systems and processes. This deal is reflective of the market’s growing collaboration between technology and business process management organizations in delivering large scale transformational work.

A pivotal deal in Firstsource’s digital journey, our BPaaS solutions for healthcare companies and collaborative approach helped us triumph over the scale of integrated services providers. This is a multimillion deal with a scope of managing core-admin health plan functions bundling Platforms, Technology Services, Business Operations and IT Infra.

Turn to the cloud. Harness Digital Mailroom and Data Capture solutions

Create a foundation of data integrity to drive frictionless downstream processes

Slow downstream business processes, missing information or misrouted images/documents and related traceability, compliance and member experience issues are some of the most common risks faced by traditional mailroom operations. The future of mailroom operation calls for higher accuracy, productivity, security, assured savings, and simplicity.

Our platform-based Digital Intake solution for various input formats across Health Plan functions helps achieve distinct business outcomes. Our Digital Mailroom and Data Capture services are underpinned by Sympraxis® V6, a purpose-built platform for at-scale digital intake operations. Powered by AI/ML, Multi-OCR, RPA, Analytics, Reporting, Process Mining, and a rules-based high-performance workflow engine, it supports highly automated mailroom and data capture processes, corrections and quality audits.

  • Field level transactional accuracy of 99.6%
  • Form level or document level accuracy of 99%
  • 100% TAT attained for processes – with 4 hours for an urgent appeal to 24 hours for claims and inquiries
  • 85% of transactions processed by bots
  • Seasoned team with decades of experience to execute your digital strategy

Stay ahead with Firstsource

Acclerate transaction flow and TAT

Improve compliance

Reduce operational costs by 30-40%

Enhance Member experience – NPS/CSAT

Turn traditional mail into digital assets

Streamline the way critical information reaches stakeholders

Businesses continue to rely on physical mails for interoffice communication between employees, departments, or the back office core admin workflow. Seamlessly integrate our Digital Post Office solution with your workflows to convert your mail to a digital format and securely deliver them to recipients remotely – a critical mandate in the post-COVID era. With high speed, centralized digitization, our solution helps track, audit, monitor, and control the digitized documents based on pre-defined business rules. You can also pre-configure the solution to route the mail to recipients – individuals, departments, groups or mailboxes.
  • Reduce distribution costs by over 50%
  • Slash interoffice transportation and real estate costs

Stay ahead with Firstsource

Reduce costs – up to $1 per piece of mail

Tighten compliance and security

Hasten cycle time and ensure on-time delivery

Enhance member experience and retention through proactive digital engagement

Normal Medicaid enrollment and eligibility processes will resume at the end of Public Health emergency (PHE), forcing States and Health Plans to rapidly complete pending verifications, redeterminations, and renewals. This will not only mean quickly processing significant volume backlogs within mandated timelines but also providing Members relevant support around the redetermination process to prevent disenrollment and protect revenue.

MReD, our modularized Medicaid Redetermination solution, blends digital engagement with proactive outreach to help States and Health Plans drive timely redeterminations even as they focus on the ongoing vaccination drive. It helps members seamlessly navigate the redetermination process, improving outcomes within three months of implementation.

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Experience the power of synchronicity in business operations

Focus on your core business and strategy

The pressure to innovate, create value, and focus on your core business is real. Reinvent conventional business processes and workforce models to manage the ever-increasing volume and complexity while keeping costs down and improving the quality of services – using automation, AI, and other proven technologies.
Our Core-Admin Business Process as a Service (BPaaS) moves away from traditional outsourcing to an outcome-based end-to-end platform enabled strategy. A layered operating model, it brings together multiple capabilities with a simplified engagement model and financial construct. We take control of your system, infrastructure, platform, and operations, enabling more meaningful SLAs and influencing better downstream outcomes based on upstream levers. For instance, improved claims accuracy driven by better Provider data accuracy or improved benefit accuracy.

Stay ahead with Firstsource

Reduce operational costs by 30-40%

Improve agility and quality of service

Optimize Medical Loss Ration (MLR) and Administrative Loss Ration (ALR)

Enhance transparency and synchronicity among teams

Heighten customer experience, satisfaction and retention

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Stay abreast with compliance mandates. Streamline Member experience

Optimize operations and outcomes with a comprehensive set of digital services

Revamp Medicare Services through our Medicare Health Plan in a Box offering. Our end-to-end solutions span Plan Setup, Hosting, IT Infrastructure, Application Management, Data Management, Business Process Services, Business Dashboards, Consulting and Training.
Backed by seasoned Medicare SMEs, the IT and Operations team provides services across Enrollment, Premium Billing and Reconciliation, Claims Adjudication and Adjustments, Product Configuration, Member and Provider Services, Appeals and Grievances, Provider Contracts, Credentialing and Provider Data Management. Our Medicare plan specific services include Medicare Risk Adjustment, STAR rating, and CMS Reporting.
A simplified Per Member Per Month (PMPM) based cost structure ensures low setup costs and Capex, with a strong focus on improving the Member experience.

Stay ahead with Firstsource

Rapid implementation

Agile operations at lower costs

Superior claims accuracy

Lower montly interest and penalties

Decreased Provider fallout

Enhanced STAR rating

Reduced revenue leakage due to risk adjustment

Digitize Medicaid operations. Reduce complexity

Pivot to dynamic consumer-focused operations

Our end-to-end solutions are designed for Health Plans looking to balance their portfolio with state Medicaid programs. Solutions include Medicaid Plan Setup, Hosting, IT Infrastructure, Application Management, Data Management, Business Process Services, Business Dashboards, Consulting and Training
A combined team comprising Medicaid SMEs, IT and Operations experts, provides services across Medicaid Enrollment, Billing and Reconciliation, Claims Adjudication and Adjustments, Encounter Submission, Product Configuration, Member and Provider Services, Appeals and Grievances, Provider Contracts, Credentialing, and Provider Data Management. Our Medicaid plan specific services include State Reporting.

Stay ahead with Firstsource

Rapid
implementation

Agile operations at lower costs

Superior claims accuracy

Lower montly interest and penalties

Improved Auto Adjudication Rate and Encounter First Pass Rate

Decreased Provider fallout

Enhanced quality scores

Reduced revenue leakage through reconciliation

Redefine the claims lifecycle for rapid, accurate grievance settlement

Tap into an automated platform for fast, effective, transparent services

We understand how important it is for you to expedite appeals and grievances and rectify complaints with quick, precise resolution. Our configurable and automated Healthcare Payer BPaaS solution provides unparalleled transparency and business controls for cases – from intake to disposition.

The solution automatically prioritizes appeals and grievances, reducing manual intervention and ensuring that Members and Providers get the coverage and customer service they need and expect. It also establishes a feedback loop for continuous improvement in core admin processes and uses appeals and grievances data to improve Member satisfaction.

Stay ahead with Firstsource

Unparalleled visibility and faster turnaround

Improved agility and quality of service

Reduced regulatory risks and auto forwards

Enhanced transparency and control

Elevated Member and Provider experience

Build the Provider network of the future

Modernize credentialing, contracting and Provider network management

Are you looking to reduce the cost of operations for Provider credentialing or monitor the Provider network to ensure consistency? Or are you considering shifting your focus to quality Providers? Whatever your need, we can help.
Our Provider Lifecycle Management Business Process as a Service (PLM BPaaS) solution supports end-to-end Provider network management and credentialing. Powered by AI/ML and automation, the platform auto-fills most applications, decreases manual effort, and reduces erros by leveraging best practices.

Stay ahead with Firstsource

Cut credentialing time by 50%, onboard Providers faster

Improve Provider data quality and experience

Slash credentialing and network management costs

Enhance Provider Directory accuracy

Boost contract configuration accuracy

Lower regulatory risk for Provider Directory

Power frictionless downstream processes

Empower your brokers to optimize sales

Grow Member enrollment

The growth of your business depends on the strength of your relationships with your brokers. Our fully integrated Broker Management solution covers all areas of operations – from consolidating sales channel data sources and managing broker operations to optimizing incentives and compensation. The customizable solution leverages in-built automation to manage commissions, brokerages and incentives, enabling on-time, accurate and compliant operations.
Integrated with various modules to support multiple devices, the single access point portal improves transparency among multiple stakeholders by providing real-time data reporting and workflow management. The platform can also be used for disseminating custom marketing materials, providing broker summaries and so on.

Stay ahead with Firstsource

Shrink credentialing and broker admin costs

Enhance Producer data quality

Elevate Producer experience

Incentivize brokers accurately