Integrated Solutions + Enriched Information + Powerful Technology = Competitive Advantage
Organize Workflows and Improve Productivity
• Add and update provider information quickly.
• Consolidated, cross-functional views to manage the entire provider relationship.
• Robust and granular search capabilities.
Integrates seamlessly with FINEOS Claims and FINEOS Payments
• Helps to ensure providers are certified and qualified for the services provided.
• Reduces the need for upfront approvals on low cost treatments, resulting in faster service provision to patients.
• Provides easier access to more comprehensive information for decision making.
• Improves ability to more effectively manage provider performance and reduce overall cost of claims.
Leverage cross-functional information to gain insights and opportunities
• Manage claims expenses through analysis of provider practice patterns, as well as diagnosis and procedure profiling.
• Enables monitoring of claims and payment trends to identify potential fraud or treatment abnormalities.
• Ensures invoices and payments are accurately aligned with service contracts.
• Reduction in claims handling expenses through automated decisions.
Key Features:
• Register and manage provider records: credentials; services and fees; contracts, payment preferences, locations, service types, networks.
• Collaborate with providers at case level to improve patient outcomes.
• Coordinated rehab planning.
• Robust search engine with comprehensive access to provider, payment and claim information.
• Rule-based analytics and reporting to manage claims costs and negotiate provider service fees.
• User-configured triggers for provider performance management and early identification of abnormalities.
• Case management frameworks ensure cases are handled in a consistent, high quality manner
Impact and Outcomes of FINEOS Provider
Increase Carrier Satisfaction
-Deepen provider relationships through streamlined requests for information, automated approval authorizations, invoicing and payment processes.
– Increase carrier’s ability to track and manage provider performance.
– Pay claims faster with integrated provider authorizations, invoicing and payments.
– Improve patient outcomes through more effective collaboration between service provider and case managers.
– Quickly respond to changes in the market.
Reduce External Claims Management Expense
– Leverage provider information and analytics to negotiate lower rates.
– Conduct analysis by service type and cost to identify the extent of over-servicing and establish more thorough clinical guidelines.
– Reduce outside claims expenses associated with commercial mapping software to locate service providers.
– Prevent fraud with early identification of abnormalities in practice patterns.
– Manage provider agreements more effectively.
– Ensure consistency in provider expense management at the local level.
Improve Operational Efficiency and Effectiveness
– Reduce time and costs associated with service inquiries and requests for information.
– Spend less time tracking information and manual reconciliations.
– Prevent duplication of provider information through online validity.
– Manage workflows and exceptions through user-configured business rules.
Modernized Technology
– Open Core System with greater flexibility and interoperability across platforms.
– Designed for the B2B2C model in Life, Accident, Health, Group, Voluntary and Individual markets.
– Role-based capability sets support
