The changing face of the health insurance industry, evolving technologies, presence of legacy systems, and need for better economic efficiencies demand for an co-sourcing partner with significant knowledge and expertise in the healthcare industry and more importantly, payer applications. The team at Calpion has years of experience in working at varying technology and operational tasks for our payer client base.At Calpion, we offer both Payer Solutions and Payer Services for  Technology and Operational needs to cover the implementation, development and maintenance phases of payer systems.

Calpion Payer Solutions

Enrollment solutions

Automating enrolment processes for both commercial and medicare plans can bring about significant reductions in enrolment costs. Standardizations by HIPAA help in developing electronic solutions and “e-enrolment” is being adopted aggressively by the industry today. Calpion has valuable technical and functional expertise to assist you with your “e-enrolment” initiatives.

Calpion Payer Services

All high growth payers commonly face the scenario of disparate databases and systems, duplicate data and the urgent need to generate accurate enterprise level reporting and data analysis capabilities. With Calpion extensive experience in extraction, transformation and loading using multiple technologies and techniques, your data warehouse and business intelligence needs can be met quickly. We partner with you to allow you to focus on interacting with your customer re their reporting and information needs while we manage the implementation.

Claims adjudication

Calpion helps several payers by maintaining their claims adjudication system. We are instrumental in helping our customers achieve a high rate of auto adjudication through tactical and strategic enhancements to the system. We have experience with several claims systems including facets, MHC etc.

 

Medicare Operations

Calpion can help its payer customers achieve higher data quality on their medicare products. We routinely help our customers perform data analysis and generate reports to comply with medicare regulations.

Care Management

Care management function is intended to provide a unified view of a member: medical claims, pharmacy, disease management, interventions, outcomes, communications and reporting. Calpion can assist with developing a care management platform or implementing and supporting a third-party care management package.

Provider

Providers of care form the essential core of our healthcare system. They have the human responsibility of receiving patients, performing diagnosis, offering consultation, rendering treatment and the lifecycle to fully healing the patient. This comes with its own set of compliance challenges and ever growing need to ensure proper and accurate patient care.

Calpion assists providers in the following areas:

Medical Coding
Calpion’ certified Medical coders can remotely connect into the provider’s EMR/Document imaging platform to review charts and code per guidelines. Calpion signs up for SLA driven fee schedules where the entire fee is at risk. In other words, the customer pays only if they work product meets the established quality criteria

Highlights of this service:

Service Level Agreement (SLA) driven fee schedule with all fee at risk
Certified coders
Secure remote connectivity into the provider's EMR/Imaging system
Support all types of charts