Streamlining Complexities
Within healthcare operations, the dual objectives of efficiency and quality in claims processing are essential, particularly for health plans aiming to deliver value-based care. In this use case, learn how HealthAxis harnesses both expertise and technology solutions to elevate processes for a client.
Client Challenge: Navigating Efficiency Gaps Amidst Complexity
Operating as an Institutional Special Needs Plan (I-SNP) covering two states, our client grappled with intricate operational hurdles. Member-provider interactions, claims processing, enrollment, utilization management, and appeals and grievances management proved to be significant challenges. Their previous fully delegated engagement resulted in limited software usage and visibility for claims processing, culminating in bottlenecks during claims processing and diminished efficiency in supporting incoming member/ provider calls, authorizations, enrollment, and appeals/ grievances.
Solution: Orchestrating Transformation through Dynamic Engagement
The partnership between HealthAxis and this regional health plan transcended the ordinary. A symphony of collaboration echoed through highly interactive and frequent engagements starting from initial implementation continuing through today. Weekly meetings served as platforms for addressing pain points, tending to housekeeping matters, and nurturing concerns. The collaboration extended further, with configuration and call center teams convening regularly, while quarterly Joint Operating Committee (JOC) calls strategically united both entities.
Results: Redefining Operational Efficiency
By bringing claims, utilization management, call center, enrollment, provider portal, and appeals and grievances onto one portal, information is shared and tracked in real-time. The efficiency was felt immediately as teams can now collaborate and efficiently support the I-SNP plan and their membership. The partnership between HealthAxis and the client led to noteworthy accomplishments, including the successful completion of a One-Third Financial Audit and a dynamic collaboration to implement a best practice for Utilization Management.
HealthAxis by the Numbers
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Years of Experience$0B+
Claims Paid Annually0M+
Claims Processed Annually0+
Health Plans Served0+
Benefits Plans ManagedSchedule a Discovery Call
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