Sutherland Healthcare Solutions

Health Plan Solutions

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Achieving your TRUE RETURNrequires flexible, rusults-orientedbusiness processes.

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That’s why Apollo Health Street works with the nation’s leading health plans, provider network organizations, and third party administrators to create customizable, efficient solutions for their operations.

The results are lower costs, improved member and provider satisfaction, and the necessary flexibility to change with market and regulatory conditions. Our proprietary technology tools and Six Sigma based methodologies combined with a global delivery model help deliver outstanding results to our health plan clients.

Our deep clinical domain offers unparalleled resources and experience

Six Sigma methodologies facilitate measurable process improvement, beyond conventional limits

Blended shore delivery offers lower cost without sacrificing quality

Compliance program strictly adheres to HIPAA and other healthcare information regulations

ISO:9001 certification ensures strict quality management standards in our daily operations

Advanced, intelligent software ensures a strong return on investment

End-to-end business outsourcing solutions span the healthcare market

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Provider Contract Management Apollo manages all types of network affiliation changes, fee schedule maintenance, and other contracting term maintenance for physicians, hospitals, and ancillary providers.

Complex contract and pricing term maintenance

Demographic maintenance for all provider types

Network integration (merging PPO networks) and implementation of Single Record of Truth

Improved quality results in accurate claims payment and improved accuracy of provider directory information

ProviderData Management

Provider Data Cleansing and Verification (DCAV) Services Recognizing the importance of accurate provider information and the challenges in maintaining up-to-date information, Apollo’s DCAV team utilizes a variety of tools to identify and correct crucial information.

Web-based data searches

Database comparisons

Calling campaigns to reach out to providers directly, collecting and verifying information

Propriety tools that assure the best possible productivity including the collection of valid addresses

Stringent QA analysis that assures the highest quality output

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Claims Administration

Provider Matching Claims that fall out of the automated matching process can cause a significant bottleneck within claims re-pricing. We accurately match these claims according to customer business rules and return them in a timely manner so that overall claims turnaround times can be maintained.

Understanding of provider contracts and network configurations

Tailored services to meet customer needs

Meet strict turn-around-time requirement of four hours, six days a week

Management of unpredictable volume levels that fluctuate hour-to-hour and day-to-day

High levels of accuracy (>99%)

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Claims AdjudicationApollo’s claims adjudication team has significant experience in claims administration with our senior team members bringing more than 20 years of knowledge. The Apollo team processes millions of claims every month.

Meeting high-volume needs with financial accuracy and turnaround times of 12 hours or less

Offering a variety of methods including via customer systems, web-based tools, or internal applications

Handling of specific and aggregate stop-loss claims and managing split retentions, aggregating specifics, and complex catastrophic claims

Reducing claims errors using root-cause analysis, providing valuable feedback along with accuracy ratings

Managing the most complex COB and subrogation claims, with timely follow-up for those requiring long-term status reviews and updates

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Front EndData Capture Services

Apollo provides full mailroom services from our state-of-the-art fully secure onshore facility. Our document preparation and scanning services include both standard and non-standard forms, including RX receipts that require special handling. Using Onbase imaging, Apollo professionals capture customer specific data elements from scanned images and assign indexes which allow prompt and efficient image retrieval.

Access to fully secure mailroom services, including data capture of incoming mail

Accurate, high-speed scanning of paper files which is manually audited

Efficient and secure image storage and retrieval

Ability to process over 800 different file formats

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CustomerServices

Apollo’s award-winning customer service is the right solution for healthcare organizations looking for a personal touch and efficient operation through call center interactions.

Global resources to efficiently administer customer service, with 24/7 availability

Voice professionals with rigorous and ongoing training

Customized staffing models that provide the required Average Speed to Answer (ASA)

Continual monitoring of abandonment rate to maintain the required service level

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NetworkManagement

Provider Recruitment Services Provider Recruitment is time consuming and requires extensive follow-up efforts. Apollo maximizes the success of recruitment programs using highly-qualified professionals who can communicate efficiently and effectively with all types of providers, explaining contract terms and overcoming objections.

Proprietary web application to streamline provider recruitment process

Management visibility to status of each provider through the entire life cycle of recruitment

Analysis of providers’ reasons to decline network membership

Assistance with health plan and PPO strategies to improve recruitment results

Smooth integration of Apollo’s call based recruitment efforts with client’s on-site

recruitment efforts

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Credentials Verification Organization (CVO) Apollo’s CVO collects, compiles, and verifies primary source verification required within the credentialing process. Our proprietary software enables efficient management of the credentialing process leading to high quality, quick turn-around times and increased productivity.

Streamlined credentialing process

Adherence to customer-specific business rules to accommodate any special credentialing needs

NCQA and URAC guideline adherence

Smooth integration of Apollo’s proprietary software with your credentialing application

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Eligibility Maintenance

Apollo’s eligibility specialists follow customer-specific business rules to maintain accurate eligibility data tailored to any turnaround time requirements. Mass or individual updates are completed from images or spreadsheet formats, with image storage and retrieval capabilities.

Population of census information into underwriting tables, leading to increased

underwriting efficiency

Prompt and accurate generation of policies and identification cards within

customer-specific timelines

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PlanMaintenance

Apollo professionals are experts at plan building and maintenance on a variety of applications and can meet stringent accuracy and turnaround time requirements. Our team can handle benefit designs by benefit code, revenue code, CPT, ICD9/ICD10, or other customized methodologies.

Customized plan building and maintenance by experienced professionals using virtually any methodology

Creation and ongoing maintenance of rate tables, cost breakouts, and tracking

Billing statements provided with complete premium collection and reconciliations

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Contact Us TODAYTo Learn More

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www.sutherlandglobal.comWebsite

SGS.Healthcare@sutherlandglobal.comEmail

+1-800-388-4557Phone

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