Claims Excellence

End-to-end Claims Processing & Adjudication

Our comprehensive approach to claims processing and adjudication encompasses every step of the process, ensuring timely and accurate handling of claims:

Automated Claims Submission

Utilizing advanced technology to facilitate the electronic submission of claims, reducing manual errors and speeding up the processing time.

Real-Time Eligibility Verification

Implementing real-time checks to verify member eligibility at the point of claim submission, ensuring accuracy and preventing delays.

Advanced Adjudication Systems

Employing sophisticated algorithms to adjudicate claims accurately, taking into account complex policy rules, coverage details, and prior authorizations.

Transparent Communication

Keeping all parties informed throughout the process with automated updates and accessible reports on the status of claims.

Payer Contracting & Rate Negotiation

A strategic approach to contracting and rate negotiation is essential for maintaining financial health and ensuring access to quality care for members. Our services in this area include:

Data-Driven Negotiation Strategies

Leveraging comprehensive data analytics to inform contract negotiations, ensuring competitive rates that reflect the quality and value of healthcare services.

Partnership Development

Working closely with healthcare providers to develop mutually beneficial agreements that support value-based care initiatives and member health outcomes.

Fraud Detection & Prevention

Fraudulent claims not only lead to financial losses but can also compromise member trust and regulatory compliance. Our proactive fraud detection and prevention measures are designed to protect your operations and financial integrity:

Advanced Analytics and AI

Utilizing artificial intelligence and machine learning algorithms to analyze patterns and identify suspicious activities indicative of fraud.

Real-Time Monitoring

Implementing systems for the continuous monitoring of claims and transactions, allowing for the immediate detection of potential fraud.

Investigative Support

Providing expertise in the investigation of suspected fraud cases, including the collection of evidence and coordination with law enforcement if necessary.

Education and Training

Offering training programs for staff on the latest fraud detection techniques and preventive measures, fostering a culture of vigilance and compliance.

At Solaris Support Solutions,we understand the critical importance of efficient and accurate claims management for payers and insurance companies. Our Claims Excellence services are specifically designed to address the complexities and challenges of the claims process, from initial submission through adjudication and payment. Leveraging state-of-the-art technology and deep industry expertise, we ensure that claims are processed accurately and efficiently, reducing costs and improving member satisfaction.