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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Our Solutions.

 eBenefitSync | Simplify Benefit Plan Configuration

SIMPLIFY BENEFIT PLAN CONFIGURATION.

Automate the end-to-end benefit product lifecycle.  Improve speed to market of government and commercial business and automate compliance document generation. Cut admin costs.  And create a paperless streamlined workflow.

 
 eMedicareSync | Streamline Medicare Advantage Compliance

STREAMLINE MEDICARE ADVANTAGE COMPLIANCE.

Leverage our turn-key CMS PBP integrated (import and export) solution to generate all compliance documents (ANOC, EOC and SB) using paperless, streamlined workflow. Improve speed to market, reduce admin costs, and lower risk of penalties.

 
 eProviderSync | Simplify Provider Data Contracts

SIMPLIFY PROVIDER DATA CONTRACTS.

Simplify provider data, enrollment, and contract configuration.  Improve compliance on provider directory, and auto credentialing.  Create streamlined, paperless workflow.

 
 Advanced-Payment-Platform (AP2) | Automate FFV Reimbursements

AUTOMATE FFV REIMBURSEMENTS.

Improve FFV (Fee for Value) payment accuracy, transparency, compliance, and timeliness. Create streamlined, paperless workflow.

 
 

Case Studies.

 eBenefitSync | Case Study

eBenefitSync

A large Health Plan consortium improved speed-to-market by 70%. Reduced data redundancy by 90%.

 eMedicareSync | Case Study

eMedicareSync

Health Plan generates 100% accurate Medicare compliance documents on time. Reduces effort and admin cost by 75%. 

 eProviderSync | Case Study

eProviderSync

Health Plan selects eProviderSync to integrate all provider data and contracts into a single source of truth.

 Advanced Payment Platform (AP2) | Case Study

AP2

Health Plan improves FFV payment accuracy, processing time,  transparency, compliance and timeliness.

 
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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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