Claims Processing Services

Claims Processing Administrative Outsourcing Services

Maintaining expertise in all areas of Medicaid claims processing and technology is a daunting challenge. Especially if you’re managing day-to-day healthcare business at the same time.

Our claims processing administrative outsourcing service features a range of back-office services. From application installation to implementation support, we can provide the following integrated claims processing services for your organization.

Claims Processing Services Highlights

• Member enrollment and service coordination

  Member eligibility tracking and maintenance; primary care physicians’ selection, tracking and maintenance; member ID-card production.

• Provider-enrollment services

  Provider application, date-changes and inquiry processing; pricing schedules administration; enrollment-documentation maintenance.

• Referral and pre-authorization management

  Capture, maintenance and tracking of member and provider case-management events and activities.

• Claims processing administration services

  Claims receipt, imaging, OCR, data entry, error resolution, medical-review processes; real-time pharmacy claims adjudication and prospective drug utilization review processing; drug-rebate processing.

• Utilization-management services

  Billing-issue identification, including overpayments and incorrect billing practices; fraud-and-abuse case identification and development; decision support and data-warehouse development and operation.

• Financial-management services

  Financial reporting; production and distribution of statements and checks; maintenance of accounts receivable; adjustment processing.

• Reporting capabilities

  Explanation of Payment/Explanation of Benefits notice production and distribution; ad-hoc report creation; report generation and distribution. 

Handling extensive back-office services requires having visibility into your operations. To be able to address change—any change. And with our 3D Blueprinting approach, we can help you gain the visibility you need to deal proactively with change. Because we help you see the connections among your strategy, processes and infrastructure. Gaining a transparency that allows your organization to be more agile. More responsive. More secure.

For the past 25 years, Unisys has been a leader in providing information solutions and operations support services to Medicaid state agencies, consistently demonstrating technical and administrative capabilities and thorough understanding of the Medicaid program.

Today, our system and administrative outsourcing claims processing services serve the Medicaid needs of 2.8 million US recipients in three states — West Virginia, Louisiana and New Jersey.

See how our claims processing outsourcing services can help your organization increase its agility, so you can focus on your healthcare business. Contact Unisys today for claims processing services.