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Case Study
Claims Processing

Client Profile
Our Client was founded over 12 years ago with the intention of improving the health of senior members by providing access to high quality, cost effective health care.

It is a community-based local network, providing coordinated care to members in small to medium-sized communities across the United States. They offer a variety of value-oriented Medicare Advantage health plans, and exercise the utmost standards of dignity, compassion, understanding and respect for their members. They have a member base of approximately 65,000.

Client’s Pain Points

  • The Client was a new start up and wanted to market its plan aggressively to the Rural Segment
  • It had an ambitious business plan of increasing its membership base from 20K to 75K over a period of 3 years. For this they wanted to focus their attention on marketing activities rather than day to day operations
  • It faced with issues on Quality, TAT, Training and coordination with its earlier vendor

e4e Solution

  • e4e’s rich talent pool and extensive experience in various claims processing software (such as Velocity, Diamond, Power MHS, Prime Meridian) made it easier to process clean claims in a much shorter time frame

The Results

  • Average clean claim processing time was brought down from 30 days to 10 days
  • The overall quality level improved from 96% to 98%
  • The Client has been able to negotiate better rates with Hospitals and Physicians and also sign up with more network providers
  • With the assistance provided by e4e on claims processing, the Client has been able to concentrate and improve its TAT on complex claims and save numerous dollars

Service Levels

  • Clean Claims End-to-End Processing – 8 Days
  • Quality: Overall accuracy - 98%
  • Financial accuracy - 99%
  • Procedural accuracy - 97%
  • Enrollment Entry & Audit - Within 24 hours

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Client Thoughts

"The dedication from our e4e teams to provide the best possible services is beyond comparison."

"We are amazed and pleased with…the difference the e4e team is making to our inventory levels."

"All work being performed by you is good and very well appreciated."

"We really appreciate all that you do to help make us a better company and increase our business's revenue."

"e4e continues to be a key player in the success of our company."

"They are very accurate in their work and are very responsive to our changing needs."

"By utilizing your services, we are able to focus more on our client and strengthen our core delivery."

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