Healthcare Revenue Management Cycle
(TPA in Medical Insurance)

Automate TPA Process for Faster Account Receivables: HIMS Integrated with TPA Software for Uninterrupted Claim Processing.

Automate insurance claim process save 40% of your admin’s time.

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Claim processing for both emergency and planned admissions.

Customise claim processing aspects as per your need

Ageing dashboard and real-time claim status reporting

Demonstrated reports- in and outflow of financial transactions

Advanced AI system tracks and isolates frequently disallowed items.

Overview of Ezovion Healthcare Revenue Management Cycle/TPA Management

Enhance efficiency by integrating Healthcare Revenue Management Cycle/TPA in medical insurance to ensure a smooth approach to insurance claim process management solutions. Speed-up your insurance claims processing, payer, policy administration, claim document and data management which can improve overall process efficiency.

Payer and Patient Management

The Healthcare Revenue Management Cycle/TPA system helps hospitals manage payers, ensuring effective collaboration and communication. Accurate and secure handling of patient information, enhancing enrolment process and maintaining comprehensive profiles for error-free claim processing.

Payer and Patient Management

Payer Management

Manage payer details, and activate or deactivate payers.

Rate Management

Payer-wise rate management for easy and accurate billing processing.

Mapping Patients

Track your patients with a payer with just one click.

Planned or Emergency Claim

Our Healthcare Revenue Management Cycle software supports planned or emergency admission claim processing or you can customize your claim process according to your requirements.

Planned Admission

Helps to complete pre-authorization, admission, treatment, and discharge for planned admissions.

Emergency Admission

Get admitted, pre-authorization by the hospital, treatment, and discharge in case of emergency admissions.

Report Generation

Generate reports based on admission/claim type for efficient claims tracking, claim management and faster settlement.

Pre-Authorization Process

After the patient is admitted, document their eligibility, enrollment status, policy coverage, deductibles, approved services, and limits for quick and efficient tracking and settlement.

Claim Numbers

After the claim is authorised, the claim number will be assigned.

Pre-authorised process documents Management

Update pre-authorised data, upload all pre-authorised process documents.

Eligibility Check

Notify the patient if the patient is not eligible for benefits.

Document Management

After the admission of the patient, initiate uploading documents for storing, and retrieving essential documents related to every Healthcare Revenue Management Cycle/TPA interaction and claim processing.

Document Maintenance

Manage and store claim process required documents.

Secured storage for documents

Documents are stored in a secure system to retrieve when needed and for an efficient audit trail.

Compliance management 

Maintain compliance and identify any irregularities in the claims process.

Submit a Claim, Bill Adjustments and Claim Adjudication

After a patient is discharged, our revenue cycle management in medical billing assists you in recording each phase, from claim submission to bill adjustments and claim adjudication.  

Upload essential documents like discharge summaries, investigation reports, pharmacy bills, OT implant invoices, and hospital invoices.  

Modify payment terms as necessary, and manage settlements, disputes, and generate reports. See screenshots for a visual overview. 

Claim Adjudication

Provision to correct missing or incomplete information for the claims requires additional scrutiny; Appeal denied claims.

Comprehensive Audit Trail

A comprehensive audit trail is maintained to track changes and decisions made during the adjudication process.

Quick Resolutions

Revenue cycle management in medical billing allows the claim adjudication process, reducing errors and expediting the assessment of claims for quicker resolutions.

Payment Processing and Outstanding

Record the payment method and details from the payer’s claim payment, along with any remaining outstanding balance. Additionally, document appeals on claims, if necessary, by supplying additional information and arrive at a final determination. 

Status Updates

Claims status is updated automatically, accounts receivable, and payment management.

Allow and disallow invoices

The software allows you to mark disallowed invoice items, write-offs, or waiver of pending dues, claim statuscloses and reporting.

Aids in account reconciliation

The system aids in account reconciliation by tracking billing, payments, and other financial transactions, promoting accuracy and transparency.

Communication

Healthcare Revenue Management Cycle/TPA processes starting from claim initiation to get the payment closed, needed lots of communication between all the stakeholders for faster accounts receivables. 

Transparent Communication Management

TPA software Integrated with the HIMS system gives you a holistic way of communication.

Claim data management

Comprehensive claim data management helps efficient communication.

Integrated SMS facility

SMS integration for real-time communication.

Reporting & Dashboard

Ezovion HIMS offers robust reporting and dashboard features, providing hospitals with insights into their Healthcare Revenue Management Cycle/TPA interactions, claims status, and financial metrics. 

Our HIMS incorporates a tracking tool to monitor the status of claims, ensuring that each stage of the process is efficiently managed and reported.

Payer management details

Payer-wise inpatient list and claim reporting.

Payers Disallowed details and reports

Payer Disallowed Detail Report, TDS Ledger, Dispute bill list.

Reports and claim status

Write-off list, Live claim status reporting, Track and isolate frequent disallowed items, Aging reports.

Ezovion TPA Management Pathway

The entire Healthcare Revenue Management Cycle/TPA management process acts as a link connecting insurance companies and hospitals. In this process, Ezovion can assist you in organizing internal tasks such as managing payers and patients, handling planned and emergency claims, and overseeing documentation for future reference.

Start with Ezovion TPA (Healthcare Revenue Management Cycle) in Medical Insurance to Enhance the Efficiency, Accuracy, and Effectiveness of Your Insurance Claim Management

A powerful Third-Party Administrator (TPA) or Healthcare Revenue Management Cycle service that allows healthcare providers to focus on delivering quality care while ensuring a smoother and more reliable reimbursement process.

Integrate Ezovion TPA Management System with Your HIMS to Make Your Process Effortless

FAQs

It is essential to recognize that third-party administrators/Healthcare Revenue Management Cycle function as intermediaries between the insurance company and the policyholder. Consequently, they may not possess exhaustive information, as they are not the ultimate decision-makers. While they assist in claims settlement and investigations, the final approval or denial of a claim rests with the insurance company.

No, Healthcare Revenue Management Cycles/TPAs and agents serve distinct roles. Insurance agents comprehend your coverage needs and assist in selecting the most suitable policy. On the other hand, TPA in medical insurance functions as intermediaries handling various policyholder-related responsibilities.

The services offered by Healthcare Revenue Management Cycle/TPAs are integral components of your insurance plan. There is no requirement to make additional payments for TPA in medical insurance services.

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