Technical & Non Technical Service Support Towards HealthCare Industries
It can be challenging to maintain a competitive advantage and optimize bottom-line revenues in an era of minimum medical loss ratios. Increased scrutiny by the HHS and the Department of Justice has put greater pressure on payers to create accurate HCC coding. But that can be challenging for organizations that have limited staff with which to dedicate to these efforts. Skynet's Healthcare can help. Our team of experts can:
Risk adjustment plays a crucial role in ensuring adequate payment for the Medicare Advantage and ACA beneficiaries you manage. Skynet's Healthcare can help. Our risk-adjusted HCC coding results in more accurate documentation of patient demographics, health conditions, and health status. The result is better per-member cost calculations and optimal compensation.Conducting hierarchical condition category (HCC) coding reviews is a complex but essential process for successfully managing risk in accordance with value-based contracts. We have the expertise needed to help payers prepare and submit accurate and complete data in advance of CMS deadlines. Skynet's Healthcare’s HCC Coding Review Services include retrospective reviews after treatment, concurrent reviews during hospitalization, and prospective reviews for new member encounters. This helps improve risk score quality and more optimal financial results.
Skynet's Healthcare’s team of HEDIS nurses and clinically trained coding professionals perform chart abstractions at multiple process levels on your behalf. Our global workforce has the expertise, tools, and best practices necessary to optimize the quality of source data you need for HEDIS and Medicare Star reporting.Our team of registered nurses access data per NCQA guidelines from your EMR to review encounters and perform comprehensive clinical chart reviews. This includes review of patient diagnoses, treatment, and documentation to verify that care has been rendered, documented, and coded appropriately.
Answering member inquiries in a timely manner can be challenging, especially for organizations struggling with staffing shortages. Whether clinical questions or benefits inquiries, Skynet's Healthcare Provider & Member Communication Services can alleviate these challenges by helping manage provider and member communication on your behalf. We partner with you to determine the clinical and operational levers that would have the most impact on cost and quality and then customize a communication plan that delivers the best results for your unique requirements.
By accessing information in the member’s EHR, we can effectively triage the member’s needs, route messages to the provider, schedule appointments, provide prescription refills, and coordinate admissions and discharges. This helps your members get the care they need when they need it while reducing that burden on both the provider’s staff and yours.
Skynet's Healthcare also helps with proactive chronic care management outreach to drive down costs, improve outcomes, and create lasting change for your high-risk members. Our team of registered nurses and physician assistants analyze data captured from beneficiaries’ health monitoring devices to help quickly identify issues needing proactive intervention.
We understand the importance of provider communication, which is why we include provider outreach as part of our communications services. We will proactively contact your providers to coordinate administrative tasks such as physician credentialing, as well as to share opportunities around increasing utilization of healthcare services offered under the member’s plan. It’s a win-win for payers, providers, and patients.
Skynet's Healthcare’s claims audit and workflow services help payers improve financial accuracy and comply with HIPAA and CMS guidelines. Key services include claim data capture, adjudication, and the ability to manage dual eligibility claims. Claims audit services evaluate 100% of processed claims and predictive algorithms flag claims based on error propensity, improving quality scores. Skynet's Healthcare payer claims management services harness the power of AI and RPA technologies to improve claims resolution rate and drive better cash flow.
We specialize in helping payers with member satisfaction and retention. Membership management services include member enrollment and disenrollment, Medicare advantage services, and premium billing administration. Our services leverage an artificial intelligence-driven back office to help payers efficiently manage their operations, achieve higher STAR ratings and increase member satisfaction.
Our provider data and network management services include credentialing, provider contracting, provider / facility update and maintenance, contract loading and fee schedule maintenance, and provider out-reach communication. Payers see improvements in provider data and process reporting, resulting in reduced costs, improved quality and accuracy