Premium Billing andReconciliation

Premium Billing and Reconciliation

Improve Profitability, Time to Revenue, and Service Quality

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The ever-changing regulatory environment and increasingly consumer-centric healthcare market will only amplify

demand for exceptional customer service over time. At the same time, payers must reduce costs, risk and complexity of

accurately and quickly processing transactions.

From member enrollment in federal, individual and employer/group health plans to premium billing and exceptions

management, the entire lifecycle must be timely, seamless and cost-efficient for payers to remain profitable and

competitive. Managing eligibility, premium billing and reconciliation can be especially challenging as members enroll

and disenroll in plans and payment vehicles.

By combining expert agents, leading-edge technology, and intelligent, automated solutions, Firstsource alleviates the

stress and risk – particularly during peak open enrollment periods – from some of the payer industry’s most crucial

functions throughout the entire billing and reconciliation process, including:

Prompt and Precise Responses and Resolutions

With an abundance of different health plan products available today, reconciliations never have a one-size-fits-all path

or resolution. Available options vary widely, requiring greater flexibility and staff training to ensure swift and accurate

responses.

Firstsource agents understand the nuances of different types of health plans and procedures, including Medicare and

Medicaid. In addition, our secure, automated data management systems enable staff to process physical and electronic

forms, make plan changes, explain benefits, and answer questions for new and existing members – even after business

hours and on weekends.

• Enrolling and assisting members

• Monitoring and pursuing revenue

• Managing interactions with government agencies regarding federal benefits

Premium Billing and Reconciliation

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Handling more than 80 different queues, Firstsource ensures that every single task gets a separate queue, enabling

flexibility and effective transfer of knowledge to team members to deliver faster turnaround on inquiries and exceptions.

Our agents are specially trained and equipped to manage:

Streamlined Revenue Collection and Loss Prevention

Reconciling payments with providers, the CMS and members can be complex, leading to delays in revenue collection.

The reconciliation process must ensure cases are fully addressed and enable payers to receive accurate payments in a

timely manner.

Firstsource’s premium billing and reconciliation services streamline revenue collection and prevent loss due to error

and inefficiency.

Our automated technology, centralized data management, straight-through billing capabilities, and deep industry

knowledge enable us to effectively audit and analyze billing and clinical documentation to assess the accuracy of

retrospective billing, reconcile reimbursements, and provide documentation enabling payers to address discrepancies

with minimal impact on provider relationships. In addition, our fully integrated system can reconcile billing with revenue

reports and identify potential sources of loss in the future.

Enrollment, renewals, plan changes, claim status, and day-to-day inquiries

Medicare/Medicaid member eligibility screening, follow-up

and conversion

Inbound and outbound new member enrollment

Premium reconciliation and payment calls

High-volume and after-hours coverage

ContactSimon CarltonExecutive Vice President, Client Relations(720) 539 5588simon.carlton@na.firstsource.comwww.firstsourcehealthcare.com

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• Streamline premium billing and revenue collection

• Review and reconcile payments

• Mitigate errors and revenue loss

• Enhance provider and member relationships

Combining Technology, Centralized Data and Straight-Through Billing to Help Payers:

Premium Billing and Reconciliation

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Helping customers stay ahead of the curve through transformational technologies and capabilities

Firstsource Solutions Limited is a leading provider of customised Business Process Management (BPM) services. Firstsource specialises in helping customers stay ahead of the curve through transformational solutions in order to reimagine business processes and deliver increased efficiency, deeper insights and superior outcomes.

We are trusted custodians and long-term partners to 100+ leading brands with presence in the US, UK, Philippines and India. Our ‘rightshore’ delivery model offers solutions covering complete customer lifecycle across Healthcare, Telecommunications & Media and Banking, Financial Services & Insurance verticals. Our clientele includes Fortune 500 and FTSE 100 companies.

For more information, please visit www.firstsourcehealthcare.com

Copyright © 2019 by Firstsource Solutions Ltd. No part of this document may be reproduced, stored in a retrieval system, transmitted in any form or by any means, electronic, mechanical, photocopying,

recording, or otherwise, without the express written permission from Firstsource. The information contained herein is subject to change without notice. All other trademarks mentioned herein are the

property of their respective owners.