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EDI Benefit Administration Outsourcing

A3logics Benefit Administration Outsourcing Services Transformed Integrated Solution & Standardized Processes

About Client

The client is a medical service organization (MSO), who offers comprehensive benefits solutions - hospital benefit management, disease management, 24X7 medical assistance, direct billing, network management, and claim processing. The MSO has contracted with more than 2500 health care providers & 500 financial institutions to provide substantial medical plans.

Managing these administrative tasks in their system became irresistible, it was then they started searching for an outsourcing EDI service provider to improve their competitive position while furnishing substantial cost and time-saving.

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Business Challenge

Though the medical service organization had a big team encompassing medical administrators, insurers, and care providers, despite their endeavors, the organization was facing loopholes that tug them from reaching the paramount of services.

The client had a claim processing and benefits management system integrated, which needed an indispensable upgrade. The traditional system was a mix of unwieldy and unmanageable manual workflows that obstructed the onboarding and integration processes.

The antecedent system lacked real-time medical claim processing, requisite between pharmacies, medical providers, benefits managers, and the administration. The entities were not able to process the claim efficiently, as the processes reached in different formats and connectivity protocols, leading to inaccurate responses.

The client needed a 360-real time view of the management capabilities and timely operational reporting facilities.

The NCPDP interfacing for electronic healthcare transactions ranging from process to the administration had backlogs that delayed the claim processing leading to rising complaints. Furthermore, its maintenance and support became notoriously challenging.

The MSO also relied upon manual inspection for various claims at distinctive process stages, due to which the organization couldn't match up with customer base growth. The exponential growth of the customer base also raised numerous quality checks that consumed a lot of valuable time.

Our client has dealt with multiple EDI providers for benefits administrative services but couldn't reach the paramount of outsourcing experience. The MSO had a competent in-house benefits team that managed health & welfare and pensions but lacked proficiency in benefits administration. However, it was challenging for the MSO to trust and rely on A3logics right away due to multiple partnership failures.

Our Solution

Before integrating any solution, A3logics competent team ensures that they have understood the imperative needs and standards of the customer's business. After comprehending the requirements, A3logics evaluated the fitting technical solution for the customer and their customer’s needs, which built confidence and trust in them.

This complete road-mapping leveraged A3logics to design and configure interfaces that can allow customers to connect with their entities and customers. A3logics also knew that the outsourcing EDI solution needs to be flexible and secure to handle the abundant data of its customers while validating, normalizing, and analyzing administrative data of healthcare.

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Benefits of Outsourcing EDI Solutions

The successful implementation of the EDI benefits administration solution required low-code to no code to add, update, and monitor real-time transactions that comply with financial institutions, pharmacy, and MSO rules without any pain.

Highly Responsive

The integrated EDI system was able to process new medical claims/hires registered from any third-party entity. The agile process enabled the organization to provide quick responses to the entities, which delivered higher POS satisfaction and clarity on claims payment.

High-performance

The outsourced solution furnished by A3logics delivered high-performance and scalable data procurement. Without the stress of anomalies and errors, MSO was able to utilize the solution. However, expert analysts were always ready to guide and support throughout the solution implementation & employment journey.

Scalability

The architected benefits administration solution was enterprise-level that was easily configured for the assembly line process every time without any hassle. Regardless of the complexity of data formatting, the development team is always leveraged to connect with any source systems or varied services for maintenance or upgrades.

Expert Support

A3logics has always been supportive when it comes to accruing from solutions crafted. A3logics ensure that the customer can easily employ the solution and get maximum ROI out of it. A3logics consultation services quickly address the issues and concerns of the client so that there is no interruption during deployment.

Assured Quality

MSO experienced exceptional administrative quality and operational benefits after implementing the X12 EDI integration in their systems. A3logics solutions promise regular updates and maintenance to avoid the chances of errors along with limited human intervention.

Cost-reduction

A3logics outsourcing solutions are flexible, consistent, and reusable. Their approach for implementing any solution, regardless of the services, remains the same. A3logics services also include specific training to use the software in order to utilize it in many ways. Simply put, the A3logics benefit administration services require less training and minor modification to reuse or add new client systems, all without spending much.

Here are the Results/Numbers That Speak of EDI Integrated Services

  • 90% of the configuration tasks were eased using A3logics intuitive process.

  • Outsourced benefit administration solution resulted in 48% cost savings.

  • The differences in the responses of different entities over claims were reduced to 16%.

Tools & Technology

  • SaaS

  • Custom API Integration

  • Cloud Computing

  • Artificial Intelligence

EDI Standards

A3logics follows all EDI standards to ensure security and compliance.

  • EANCOM
  • EDIFACT
  • HIPAA
  • HL7
  • IATA Cargo-IMP
  • IATA Cargo-XML
  • IATA PADIS
  • NCPDP SCRIPT
  • RosettaNet

Summary

A3logics strives to deliver a future-proof solution that can integrate with any database, system, application, or comply with any data format. The highly adaptable and extensible outsourced benefits administration solution leveraged MSO to streamline their claim processing, healthcare benefit management challenges, and comply with new technologies as well as changing industry needs.

Today, the organization is keen on deploying new transaction set integration with the support of A3logics, comprising eligibility & benefits integration - HIPAA X12 EDI 270/271 and claim status integration - HIPAA X12 EDI 276/277. Their motive is to reduce the administrative cost, upgrade their services with new features, and enhance collections & payments. If you are looking to outsource EDI solutions, A3logics is dedicated to assisting its customers in every vertical of the healthcare industry, such as TPAs, resellers, employers, insurance carriers, & more. A3logics is a one-stop solution for adaptable, pliable, and reliable EDI services.