Enhancing Medicare with Operational Efficiencies
In today’s dynamic healthcare environment, third-party administrators (TPAs) managing complex benefits must balance operational efficiency with ever-changing regulations. This case study explores how one of the largest TPAs in the country partnered with HealthAxis to streamline operations, ensure compliance, and enhance member retention through a highly configurable core administrative platform backed by dedicated client support and 60 years of experience.
The Challenge
The TPA needed a robust and flexible core administrative platform to efficiently manage its complex Medicare Part B and Supplement administration processes. As a payer focused on self-funded employer groups, they faced several challenges:
Navigating Regulatory Complexity: Adapting to evolving CMS requirements to avoid penalties and financial risks.
Enhancing Operational Efficiency: Reducing manual processes to streamline claims processing and audit preparation, reducing costs.
Scalability: Customizing solutions to meet client-specific needs without disrupting operations.
Improving Accuracy: Ensure accurate processing of claims and generating accurate and comprehensive reports.
Solution: Enhancing Benefits Administration With Flexible TPA Solutions
To address these challenges, the TPA partnered with HealthAxis for its AxisCore™ platform—a scalable core administrative solution with built-in support to streamline operations and ensure compliance.
Comprehensive Solution Provided:
All complex calculations are automated and can be totally auto-adjudicated without user involvement except when the client's business rules require the claim to stop for internal review.
These automated workflows:
- Reduced processing time,
- Improved accuracy.
- Reduced costs.
This enables the TPA to focus on strategic priorities.
Streamlined Claims Processing
All complex calculations are automated and can be totally auto-adjudicated without user involvement except when the client's business rules require the claim to stop for internal review.
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Regulatory Adaptability
Proactive updates to CMS regulations ensure ongoing compliance and mitigate financial risks. HealthAxis’ business analysts collaborate closely with the client to create detailed design documents for system updates, translating regulatory requirements into actionable workflows.
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Improved Efficiency
Streamline workflows to handle CMS audits by auto-generating PDF documents with required claim processing screenshots and images of the submitted claim form and attachments. This saved significant time and manual effort for audits involving hundreds of claims.
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Customized AxisCoreTM Technology
HealthAxis’ claims platform is fully configurable with its modular code base allowing the AxisCore™ Technology to adapt to the third-party administrator’s specific needs and ongoing regulatory and brand changes.
Results: Streamlining Operations With 40 Hours Saved Weekly
HealthAxis’ AxisCore™ Technology and tech-enabled services delivered measurable results for the TPA, improving operational efficiency, enhancing compliance, and driving member retention. By automating time-intensive processes, ensuring seamless integration of regulatory updates, and optimizing claims processing, HealthAxis helped the TPA overcome complex challenges and achieve strategic priorities.
Key Results:
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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