HEALTH PLANS & MANAGED CARE ORGANIZATIONS

Healthcare Plans and Managed Care Organizations operate in an ever dynamic market and regulatory environment. They must continually adapt their business processes to keep up with evolving business models and regulations in managed care – for example, consumer driven health plans and adoption of NPI. In addition, their technology platforms must interface with providers and other partners such as chronic disease management, specialty utilization management, third party billing and claims services companies, claims clearinghouses etc.

The following are examples of services that CitiusTech professionals provide across key business processes for payers and managed care organizations:

• Revenue and Risk Management Workflows: Help deploy applications platforms and build enhanced reporting and business intelligence.
   

• Care Management Workflows: Deploy integrated case and disease management applications and develop enhanced reporting and business intelligence.
   

• Claims and Reimbursement Management: Transition legacy applications with custom code to newer flexible platforms with configurable change management. Design and develop real-time eligibility and claims processing and capability.
   

• Provider Network Management: Develop and deploy applications for provider servicing, credentialing, contracting and claims submission.
   

• Customer Service Portals: Deploy customer service portals with online claims history, electronic EOB, and support for consumer driven health plan features such as provider pricing and account balances.

Please review our services and contact us on how we can deliver the right services to help you deliver on your technology.