Industry Trends

Health plans continue to invest in their claims systems but with the focus now on interoperability and faster release of new products than just improving efficiency of claims processing. The aftermath of the HIPAA Act saw most plans making significant investment and thus dramatically increasing the rate of electronic claims submission resulting in auto-adjudication rate of 80% or more. On the heels of this newfound administrative efficiency, health plans now face a fresh set of business challenges. Today's market conditions demand swift speed to market for new products, improved systems interoperability, and diligent preparation for the next wave of regulatory changes like ICD10 in the pipeline. In line with this demand claims systems need to now handle newer benefit designs, integrated health management, seamless portals and have to be built on SOA to increase flexibility and agility in the changing marketing conditions.

How Wipro Helps

Wipro's Claims Management solutions help address newer challenges while increasing efficiency of claims processing. Our SOA solutions enable seamless integration into existing claim flows while application of intelligent, rules-based pre-adjudication and routing logic results in higher first-pass rates, reduction in manual handling, and significant financial savings from streamlined administration. With platforms like QCare, MCare, in its arsenal, Wipro has been offering Claims Management and Reconciliation solutions to over 100 MCOs.

Wipro has over a decade experience in developing some state-of-the-art core claims management solutions and handles claims processing of the world's largest healthcare payer. In addition Wipro leverages its Healthcare BPO services to provide end-to-end healthcare transaction processing for a large US state government and offers services to other governments like being a fiscal agent for the State of Missouri DHHS Medicaid operations.

• Claims Replatform and Legacy Modernization Services
• Healthcare Application Services- Configuration, Implementation, Support on Core Platforms like Facets
• Healthcare Analytics Services – Extending to Claims, Acturials, Underwriting, Fraud, Provider Contracting
• ICD 10 Conversion Jump Start Services
• Platform based services - QCare and MCare (SaaS Model)
• Network Management