Our healthcare payer administrative BPO services address the critical functions essential for the optimal operation of a health plan. A health plan may be an insurance company, HMO, PPO, or an At-Risk Provider. We offer services to these health plans that focus on the following four critical processes:

• Provider credentialing and preparatory work
  
  Increasingly, accreditation groups, healthcare payers, and government regulatory agencies require strict monitoring of provider credentials. Mayflower’s credentialing saves our physician clients time & money by eliminating manual process and redundant tasks and most importantly credentialing for the first time. Mayflower Credentialing can increase physician reimbursement by applying their knowledge, experience and understanding. This involves an in depth understanding of those specific Managed Care panels that are keys to a practice’s successful reimbursement.
  
  
• Front End Claims Processing and Management:
  
  Even though paper claims vs. EDI claims volumes vary; most payers still handle 20-50% of their incoming claim volume via paper forms. The biggest portion of these paper claims processing comes from the required manual labor for the work.
  
  You can get more value for the effort put in by using our BPO services with very little to practically nil capital investment and minimal internal IT burden. We perform entry of data of paper or electronic claims received into the host applications for an increased auto-adjudication rate.
  
  
• Claims Repricing:
  
  We understand the importance of having efficient claims processing systems and that healthcare payers have their own unique claims management goals and objectives. We offer medical claims repricing services tailored to fit the specific needs of each client. As claims continue to grow in complexity, quality medical claims repricing done by the Mayflower team can help you to improve your bottom line and customer service.
  
  
• Claims Adjudication and Error Suspense Resolution:
  
  Following front end claims entry and handling, we manage the adjudication and resolution of all claims documents including error correction and issue resolution, workflow scheduling, quality assurance and reporting.
  
  With a view to providing a one-point services for all your needs, we have a team of Adjudicators who check the claims for its complete correctness in terms of the patient data, ICD and CPT data, the charges, allowed/payable amount and also in terms of all recently processed claims for each patient.
  
  
• Enrollment Membership and Billing Services:
  
  Utilizing our systems or client’s legacy systems ensure that members are properly enrolled so eligibility can be verified. We also ensure that employer groups are billed regularly for employee coverage.
  
  
• Customer Service:
  
  Customer service may be via telephone, email or web-based means, and it includes incoming communications as well as outbound calls and responses.