BPO Services: Healthcare BPO Through Adaptis
One reason that health payers choose Adaptis is our flexibility – customers can choose the services that they need.
Claims Processing
Our healthcare analysts work with you to design and configure all required claims processing rules. We configure benefit, provider contract, reimbursement and other information in the Qnxt application to enable accurate adjudication of claims.
Member Services
Adaptis can help you meet your members' needs with enrollment and eligibility administration and through member call center and fulfillment services.
Group Administration
We offer comprehensive administrative services to ensure all your group administration needs are covered from small to large groups.
Financial Management
Supported by the flexibility of Qnxt , Adaptis Financial Management services include claims payment, premium billing and reconciliation, and, through our preferred vendors, fraud & abuse monitoring, subrogation.
Provider Services
Your providers are your "other customers." Our customizable Qnxt sytem and comprehensive preferred vendor relationships allows Adaptis to offer provider credentialing, fulfillment, provider information maintenance, customer service and other services to respond to your care providers' needs.
Case Management
Help to improve outcomes and minimize inefficiencies for members with case management focused on assessing, planning, coordinating and facilitating the appropriate delivery of care and services. Service can include complex and chronic case management services
Utilization Management
Proactively manage your members’ use of healthcare resources. Services available include pre-certification, prior authorization, concurrent review, discharge planning and appeals.
24-hour Nurse Line
Give your members day and night access to advice about: the need to receive medical care, health conditions, general health advice, preventive care and other topics. 24-Hour Nurse Lines can reduce costly ER visits and help to produce better outcomes by helping patients with important, after-hours care decisions.
Disease Management
Pinpoint members with (or at risk for) chronic, high-cost conditions and work to improve outcomes with targeted interventions and healthcare communications.
Consumer Directed Health Plan (CDHP) Administration
From administering CDHP Accounts (HRAs, HSAs, FSAs, HOAs, and MSAs) to providing access to health education tools, Adaptis can help you respond to your members’ desire for more involvement in their ongoing health maintenance and healthcare spending.
Decision Support/Analytic Reporting
Use the power of Qnxt to gather the metrics you need to confirm business decisions; examples of services include reports, analytics, Outcomes-HEDIS, Predictive Modeling, and Provider Profiling.
Adaptis provides healthcare business process outsourcing support to small to mid-tier health payers offering Medicare Advantage, Medicaid and commercial lines of business. Our services are tailored specifically to your individual plans’ needs.
