Integrated Solutions + Enriched Information + Powerful Technology = Competitive Advantage
FINEOS Provider is a comprehensive provider administration and management software solution designed specifically for the unique needs of the life, annuities and health insurance industry. Its integrated approach with FINEOS Claims and FINEOS Payments coupled with its unified, state of the art technology platform, enables carriers to more efficiently and effectively manage the complex process of delivering superior service at the lowest possible cost.
Organize Workflows and Improve Productivity
• Single source of provider information including licenses, credentials, specialties, locations, contracts, service providers, service types, provider preferences.
• 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
• Enables collaboration and improved communications between case workers and service providers.
• 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
• Integration of claims and payment information increases ability to perform sophisticated analysis for contract negotiation, cost reduction and fraud prevention.
• 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 of FINEOS Provider
• 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
The FINEOS Platform is the only purpose-built, end-to-end SaaS insurance solution for the life, accident and health market. The FINEOS AdminSuite delivers industry leading capabilities across core administration including absence management, billing, claims, payments, policy administration, provider management and new business and underwriting; all of which are configurable to operate independently or as one suite. The machine learning enabled FINEOS Engage solution enables robust people first digital engagement pathways and the FINEOS Insight solution provides predictive analytics and reporting across the business.
