Health Plan Pain Points

Simplified.

CLAIMS ERRORS
Alert
  • Caused due to inaccurate benefit plan and provider configuration
  • Enable significant reduction in claims errors with accurate benefit and provider data
CUSTOMER SERVICE CALLS
Call
  • Benefit inquiries have long average handling times and low first call resolutions
  • Improve call handling times and first call resolution rates with real-time benefit explanation
SPEED-TO-MARKET

Speed
  • Average benefit product configuration is error prone, tedious and takes 60-90 days
  • Enable significant improvement in speed to market with business rules and workflow
COMPLIANCE RISK
Risk
  • Significant risk of compliance penalties in benefit product, MA and provider data and contracts
  • Reduce compliance risks with auto-generated compliance documents and audit trails
INACCURATE PROVIDER DIRECTORY
Database
  • Leads to penalties and customer dissatisfication
  • Improve accuracy of provider directory data by creating a single source with automated business rules and workflow
  PAIN POINTS   OUR SOLUTION
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High-tech Benefit Plan Management – Simplified

Configure complex benefit plans and achieve operational excellence with improved speed-to-market, accuracy and cost-effectiveness by up to 70%. Turn your benefit plans around in less than 3 days and dynamically generate all plan documents.

Error-Free Medicare Plan Management

Achieve maximum growth with easy and error-free Medicare plan management and generate 100% accurate compliant documents on time. Improve your Medicare Star Ratings with automated CMS PBP bid submissions.

Restructure Provider Data, Directory and Contracts

Make your Provider Data, Directory and Contracts accurate while improving compliance and quality. Consolidate Provider data and contracts into a single source of truth. Eliminate disparate legacy systems and error-prone processes.

Value-Based Payments: Quality over Quantity

Helping Health Plans deliver “VALUE” in Value-based care with 100% accuracy, compliance and transparency. Automate value-based reconciliation and operationalize every phase of your FFV payment programs.

Digital Business Process with a suite of Transformation

Automate and transform any manual or semi-automated business processes with suite of tools that are business friendly, easy to implement and maintain by the business teams.

Ready to Get Started?

See how our business-rule driven solutions enable Health plans to automate various administrative processes and improve accuracy, compliance and timeliness by up to 75%.
Yes, you can simplify your manual and inefficient processes.

 

What our customers say.

BENEFITS BUSINESS LEAD

Simplify Healthcare development team was responsive, knowledgeable, and definitely seems to ‘get it’. I’ve used their benefit administration product for over 4 years, and each time a new release is rolled out I am impressed with their ability to understand our requirements and anticipate the functionality we need most.

DIRECTOR - MARKETING COMMUNICATIONS

eMedicareSync reduced 75% time and effort to build Medicare/Medicare Advantage products and auto-generated all documents in time and with quality. This was our first CMS submission where there was no chaos due to last minute changes.

FORMER LARGE HEALTH PLAN PROVIDER EXECUTIVE

In my opinion, eProviderSync is the only end to end solution that can help solve the Provider data and contracting challenge in the industry at the root cause. It creates a robust, configurable single source of truth and has a intelligent algorithm to the keep the data updated.

VBR PROJECT MANAGER

We had exceptionally aggressive timelines to deliver and deploy a very complex payment reimbursement system. Simplify Healthcare was able to meet the deadlines, even as our customer continued to add requirements while we were in trial testing. Their team worked many nights and weekends to enable our Plan to go live on time.


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Ready to get started?

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