Live Claims Management

Our Live Claims Management service is designed to help hospitals reduce the time and effort spent on managing claims, and to ensure that they receive payment for services rendered in a timely manner. We offer end-to-end support for the claims process, from the front desk to reconciliation, and work closely with hospitals to ensure that claims are properly documented and submitted.

Our team of experienced professionals is skilled in all aspects of the claims process, including preauthorization, reauthorization, and analysis. We handle all communication with payers, and work to resolve any issues or challenges that may arise.

In the event of delayed or denied claims, we offer comprehensive support for handling these issues and securing payment. We are skilled in negotiating with payers and working with hospitals to appeal denied claims, and are committed to helping our clients achieve optimal revenue capture.

Seven Sigma's Live Claims Management service includes the following steps:

step 1

Obtain preauthorization

Before treatment begins, we work with hospitals to get approval from payers for the services to be provided. This includes reviewing the treatment plan, verifying coverage and benefits, and communicating with payers.

step 2

Ensure proper documentation:

We help hospitals complete and submit all required documentation, including treatment plans, medical records, and billing information.

step 3

Submit claims

We take care of submitting claims to payers, making sure all necessary information is included and that claims are properly formatted.

step 4

Follow up on submitted claims

We follow up with payers to ensure that payment is received in a timely manner. If there are any issues with delayed or denied claims, we work to resolve them and secure payment.

step 5

Analyze claims data

We analyze claims data to identify trends and areas for improvement, and provide recommendations to help hospitals optimize their revenue streams.

step 6

Reconcile payments

We reconcile payments received with the submitted claims to ensure that hospitals are properly compensated for their services.

Seven Sigma's Live Claims Management service supports a variety of insurance schemes, including:

Private insurance:

These are insurance plans that are purchased directly by individuals or employer groups.

Government-funded insurance

These are insurance plans that are funded by the government, such as the Ayushman Bharat, KASP, ECHS, ESI schemes

Third-party administrators (TPAs)

These are companies that handle claims and other administrative tasks on behalf of insurers.

Employer-sponsored insurance

These are insurance plans that are purchased directly by individuals or employer groups.

Managed care plans

These are insurance plans that manage the cost and quality of healthcare services through various methods, such as requiring patients to choose from a network of providers or requiring prior authorization for certain treatments.

Receivable finance

We provide the receivable financing to the hospitals based on the outstanding receivables from the credit schemes through the financial partners.

We Assure You…

  • Faster reconciliation of payments received
  • Increased revenue and growth for hospitals
  • Prompt submission of claims to payers
  • Reduced disallowances, or denied claims
  • Prompt management of queries and follow-up on claims
  • Service standards are set and penalties are accepted in the event of a violation of these standards

Contact Us

Experience the peace of mind that comes with expert Live Claims Management from Seven Sigma - let us handle the paperwork so you can focus on what matters most: your patients.

Get In Touch

Contact information

We are Always Ready to Help You and Answer Your Questions

3 Offices

Vytilla, Ernakulam
Bangalore
Seven Sigma Healthtech Solutions Private Limited, No.43, PM Complex, 3rd floor, 2nd cross, Cambridge Layout, Ulsoor, Bengaluru - 560008
Perintalmanna
Jubilee Hills, Jubilee Road
Perinthalmanna
Malappuram, Kerala - 679322
Follow us

Get In Touch

We would love to speak to you. Fill in the form below and let's stay connected.

An Internal error occurred during your request!
Success! Your Request is submitted.