Healthcare Business Process Solutions

Healthcare cost escalations are posing a challenge to future business environment for organizations. The pressure to reduce cost of care and cost of operations is, thus, a key requirement. There is also a need to improve enterprise business process efficiency to manage growth that requires an end-to-end look at the entire business process. Metrics such as Star ratings, physician and patient satisfaction, operational and clinical outcomes have become table stakes requiring real-time customer responsiveness, strict regulatory compliance and effective measurement of business performance.

How Wipro Helps

Wipro has proven Healthcare solutions and services that enable business process efficiency while delivering significant cost competitiveness. We bring proven expertise and experience across the Healthcare process value chain for Payors and Providers.

Our Provider services include:

  • EMR Clinical and IT Helpdesk (Epic, Cerner, AllScripts, Meditech and others)
  • Revenue Cycle Management - Patient Access Management and ICD-9, ICD-10 Medical Coding
  • Clinical Documentation Improvement (CDI)
  • AR, Denials Management
  • Patient Accounting and Contact Center
  • Corporate Business Services - Finance and Accounting, Human resources
  • 3D Imaging Reconstruction - HIPAA Compliant Global Radiology Support Center

Our Payor services include:

  • Claims Administration Services
  • Provider and Member Contact Center Services
  • Premium Billing & Reconciliation
  • Care Management - Utilization managements, Case management and Medical management
  • Integrated Behavioral - Clinical program "feet on street" services
  • Mailroom and fulfilment services including imaging, data entry, scanning, EOB, Check, correspondence printing
  • Fraud, Waste and Abuse (FWA) Program Integrity services

A history of growth through acquisitions or decentralized/component IT systems in Payors and recent M&A trend in Providers has added significant operational complexity. The key is to standardize and simplify core business operations. The Center for Medicare and Medicaid Services (CMS) compliance has added to the complexity and audits have become more stringent.

Over last 25-plus years, Wipro is working with leading US Payors, health systems and Medicaid agencies and has delivered tremendous operational value.

Some of the business outcomes delivered include:

  • Helped settle more than $15 billion claims annually
  • Process 120-plus million claims (Medical, dental, drugs, vision, & behavior claims) annually
  • Manage 800,000-plus Medicaid beneficiaries and more than 40,000 Medicaid Providers as fiscal agent
  • Improved real-time auto adjudication capability to 100% from 60%
  • Respond to more than 10 million member and Provider calls annually
  • Conduct 10,000-plus 3D radiology reconstruction studies every year
  • Achieved 99.75% paperless claims submission, covering more than 100 million claims annually
  • Decreased average time for paper claims processing to 0.69 days from 2 days
  • Achieved annual savings of $2.9 million by automating provider claims submission
  • Improved process performance and reliability with reduced clinical and business error rates
  • Helped process 27-plus million annual claims via PoS development and maintenance
  • Helped comply with HIPAA guidelines, including ensuring increased security of transaction management