Payer Services

Business process outsourcing

Clarus provides the full range of payer business process services. The new Medical Loss Ratio Mandate has made it an important obligation for health insurances to improve their quality of administrative functions at lowered costs.

We provide personalized solutions that help insurance companies increase efficiency and reduce costs by efficiently managing their claims.

Claims Data Entry Services

We pay great attention to details during data entry for insurance claims and take steps to make sure these claims are compliant to various regulatory standards

We have expertise in handling data entry of general insurance claims, demographic information, medical insurance claims, CMS 1500, UB04 and flexible spending claims. Delays in transaction processing will lead to the end customer dissatisfaction leading to a loss of customers, which could have a negative impact on revenues and growth. At Clarus, delays are unheard of.

Our data entry services yield various benefits by

• Saving time and reducing overhead costs

• Enhanced levels of accuracy

• HIPAA compliant data center operations

• Quicker retrieval of page or document with an organized indexing system

Types of Claims Supported

Our data services include:

• CMS1500

• UB04 (Single / Multi / Attachment / COB)

• Dental Claims

• Prescription claims

• Foreign claims

• Superbills

• Miscellaneous (complex / non-standard forms)

• Pends / Correspondence

• Vision Claims

• Medicaid/ Medicare

Request for Information

Claims Adjudication Services

We have efficient experts in place to make claims adjudication a simple and convenient process. We easily manage unwanted claims, duplicate claims and delayed execution, which has a direct impact on profits. By choosing Clarus, you will be able to streamline your healthcare claims adjudication.

The process of receiving & verifying claims and settling the claims forms is a complex insurance processing task, for anyone to undertake. Instead, you can leverage our expert claims services. Our dedicated team of claims adjudicators, subject matter experts, and claims analysts will support you through the entire claims adjudication process.

Key benefits include:

• Our adjudicators are experts in processing claims with efficient analytical skills.

• Our adjudicators are specially trained in the US healthcare system and processes.

• We understand the details of International insurance regulations and work according to your specific needs, in compliance with international healthcare claims standards and regulations

• We provide maximum efficiency, quicker turnaround time, accurate recording and maintenance of records

• You can be completely confident about the security of your data as we follow stringent data security systems and legally binding security policies

Member Enrollment Services

Clarus has a well-established delivery team to provide Member Enrollment Services. We have a wide range of solutions for your back-office operations. We also have highly skilled resources to process large volume enrollments, member updates, and terminations. At Clarus, we work very closely with our clients to identify recurring production requirements and align our staffing levels to meet our client requirements.

We significantly improve turnaround times and data loading accuracy from multiple sources such as brokers and plan administrators. Our workflow platforms allow us to manage the process, auditing and initiate new planning for our clients. Clarus also handles correspondence for members, brokers and benefits managers.

Provider Data Management

Our Provider Contract Management team maintains provider contract terms in reprising and claims systems for Health Maintenance Organizations, Preferred Provider Organizations and other commercial insurance companies. Our team manages all types of network affiliation changes, fee schedule contract maintenance for physicians, ancillary providers.

Key benefits include:

• Complex contract and pricing term protection

• Demographic maintenance

• Network integration

• Improved quality resulting in more accurate claims payment

• Improved accuracy of provider directory information

• Improved productivity leading to significant cost savings

• Tailored services to meet customer needs

• Meet stringent Turn-Around time

• Management of unpredictable volume levels

• High levels of accuracy

Claims Pricing Services

Clarus helps payers reimburse providers accurately using prospective payment methodologies, knowledge base, and tools.

Key benefits include:

• Successfully manage risk using a prospective payment

• Compute reimbursement for inpatient and outpatient, out-of-network claims

• Form the impact of reimbursement strategies before implementation

• Automate regulatory updates

Appeals Processing

Healthcare payers have realized the importance of creating faster and better appeals and grievances management processes for improving end-customer satisfaction. Our technology can act as an enabler by creating process flows that drive customer satisfaction while improving productivity and reducing overhead costs. The recent regulatory reforms have improved member rights, causing a sharp increase in appeals & grievances. At Clarus, experts scrutinize provider contracts for accurate resolutions, making the process manageable and brief.