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 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 over head costs
Enhanced levels of accuracy
HIPAA compliant data center operations
Quicker retrieval of page or document with organized indexing system
Types of Claims Supported
Our data services include:
UB04 (Single / Multi / Attachment / COB)
Miscellaneous (complex / non-standard forms)
Pends / Correspondence
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 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 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 benefit 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
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 prospective payment
Compute reimbursement for inpatient and outpatient, out-of-network claims
Form the impact of reimbursement strategies before implementation
Automate regulatory updates
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 over head 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.