Claims Administration

With rise in number of insured members and government regulations, claims administration has become vital for the healthcare industry. Coforge provides best in class technology, workflows and expertise for healthcare payers. We understand the industry need to maintain the administrative and operational demand and the importance of customer experience. With our industry focus, technological driven solutions, and digital transformation capabilities we serve clients to stay ahead of the curve. The suite includes end-to-end administrative services such as:

• IT professional services for Core Payer Administration platforms
  • Implementation and Configuration Services
  • Data Migration Services
  • System Integration Services
  • Managed Application Services
• EDI Enablement and Integration Services
  • 837/835/NCPDP processing leveraging BizTalk, TIBCO, Mulesoft Anypoint
  • Encounters Submissions
• Claims Analytics Services
  • HEDIS & Star Quality reporting
  • Payment Integrity Analytics including Fraud, Waste & Abuse, Payment Data and COB validation
  • Risk Adjustment Analytics
  • HCC Risk scoring of member population for Population health management
  • Claims Data warehouse and Data lake implementation