Services

Plan Benefits Administration

Our dedicated professionals are trained to create and categorize benefit plans in accordance with client specifications, ensuring seamless integration into our software systems. We manage the creation of Benefit Plan IDs and ensure accurate loading per plan requirements, enabling efficient benefits administration.

Providers and Contracts Management

We specialize in developing contract classification codes that are essential for the accurate processing of claims. Our team meticulously sets up contracts by designing templates for both participating and non-participating providers. We maintain up-to-date fee schedules and modifiers by downloading the latest data from CMS. Additionally, we can create specific provider types and attach relevant benefit categories and fee schedules to all provider contracts.

Member Enrolment Administration and Processing

Our services encompass thorough data scrubbing and the loading of member demographic information into our systems. We ensure compliance by verifying data against government portals. Our comprehensive offerings include posting daily enrollment files to CMS, managing and acting upon Transaction Reply Report (TRR) files, and overseeing disenrollment processes.

Claims Entry and Processing

We provide our clients with robust claims entry and processing capabilities for both paper and electronic claims. Our team adeptly handles claim adjustments to rectify inaccurately paid claims and processes refund requests, while also managing claims via call center tickets. With expertise in HCFA 1500 and UB 92 claims processing, we are well-equipped to migrate various insurance processes. Our knowledge extends to analyzing reports generated by third-party claims adjudication systems to identify and mitigate potential revenue leakages. We are proficient in the Ingenix Claims Processing System, ensuring efficient and accurate claims handling.

Referral Authorizations

Understanding the requirements of Health Maintenance Organizations (HMOs), we facilitate the referral process by receiving and generating authorizations for referral requests via multiple channels, including fax, email, and telephone. We ensure timely loading of referrals and authorizations into designated software systems.

Credentialing

Recognizing the sensitive nature of credentialing, Anion offers specialized services to verify provider credentials through the CAQH database. Our well-trained team diligently follows up with provider offices to collect essential documents, such as DEA and malpractice insurance certificates, maintaining the highest standards of competency and skill in this critical area.

Re-Pricing of UB Claims Using Third-Party Portals

For claims processed under the Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS) methodologies, we utilize standardized third-party tools to ensure accurate pricing based on Medicare allowable limits for both inpatient and outpatient claims. This approach enhances coding consistency and data quality while mitigating compliance risks through built-in edits for National Coverage Determinations (NCD) and Local Coverage Determinations (LCD).

Agents Credibility Checks

In preparation for enrollment seasons, we conduct thorough background checks on all agents. Our process includes verification through the Department of Motor Vehicles (DMV), the Department of Insurance (DOI), and the Office of Inspector General (OIG) portals to ensure agent credibility and compliance.

At Anion, we are committed to delivering exceptional claims management services that enhance operational efficiency and compliance within the U.S. healthcare landscape.