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MedVision's BPaaS, Business Process as a Service, solution can help organizations of all sizes, from start-ups to those preparing to expand, to better utilize their resources. As firms develop, restructure, or want to better control ongoing operating expenditures, BPaaS alleviates some of the arduous responsibilities that they confront internally.
BPaaS
Membership
Loading of enrollment, eligibility, revenue, and capitation files based on health plan frequency - reconciliation and reporting duties
Encounters
Encounter processing and submission to health plans – guaranteeing network performance responsiveness
Providers
Loading and updating provider records and contract alignments to ensure accurate provider reimbursement
Health Plans
Upstream and downstream arrangements can be configured to be consistent in terms of reimbursement and carve-out structures.
Reporting
Producing timely utilization, authorization, and claims reports in standard and custom formats for health plan partners — ensuring important delegated processes are compliant
Workflow
Building and maintaining configurable rules that affect the routing of referrals, authorizations, or claims in the delegated value-based organization
BPaaS
Credentialing
Update data in accordance with all delegation authority and appropriate primary or secondary source verifications.
Referrals Processing
Complete utilization cycle management based on recognized medical criteria - streamline authorization process following organization's guideline policies and procedure instructions
Claims Administration
Procurement, adjudication, payment and distribution of provider and facility claims
Capitation
Ability to conduct outbound capitation payments and reconcile member reports to providers. Provide health plan usage and trending analysis to detect network leaking
Contract Negotiation
Experienced executive teams that can evaluate contracts and structures throughout the network's stakeholders, including plans, providers, specialists, facilities, and ancillaries. They are designed to help you handle issues and improve your bottom line.
Call Center Operations
Maintaining a full cycle Customer Service department capable of tracking all incoming calls, routing to suitable people, and integration with other departments such as claims and referrals for faster call resolution.
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SOC Certification Achievement
MedVision has successfully met the criteria outlined in the SOC (System and Organization Controls) audit for service organizations. This certification demonstrates MedVision’s adherence to rigorous standards for security, availability, processing integrity, confidentiality, and privacy.
As a service provider managing sensitive data and overseeing critical functions on behalf of clients, this certification underscores MedVision’s commitment to maintaining high standards of operational excellence and data security.
HITRUST Risk-Based 2-Year Certification Achiever
The Health Information Trust (HITRUST) is a standards organization dedicated to security, privacy, and risk management. They developed the HITRUST Common Security Framework (CSF), which assists organizations in maintaining a comprehensive and secure approach to HIPAA compliance and managing risks. HITRUST is widely recognized as the benchmark in data security and privacy.
Certified Member of HCAA
The Health Care Administrators Association is the nation's largest nonprofit trade association for third-party administrators, stop loss insurance carriers, managing general underwriters, audit firms, medical managers, technology organizations, pharmacy benefit managers, brokers/agents, human resource managers, and health care consultants. HCAA has spearheaded the change of self-funding for more than 35 years.
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