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Elevance Claims.pptx
- 1. © FIRSTSOURCE 2023 | CONFIDENTIAL | 1 ClaimsExperienceandCredentials 55 M Manual Claims Processed Annually 20 Health Plan Clients Including 6 top 10 $ 3.7 B Payments Processing per month $20K - $250K Independent Adjudication 30% Claims processed by BOTs 40% Complex 40% Medium 20% Simple 4,640+ Experienced Claims Examiners 99.9% Financial Accuracy 99.6% Payment Accuracy > 99% in 2 Days Claims TAT National, Government, Commercial plans - Claims Adjudication Medical and Dental Claims Adjudication Underpayment, Overpayment Recovery & Refund Claim Adjustments, Appeals, Escalations, Checks, Correspondence ASO - Government and Indigent Plans CDH Plan Administration Rework and Reconciliation PROCESSES Pend/EDIT Resolution and Automation Services High-Cost Claims Processing Late Payment Interest Processing Blue Plans - BlueCard, FEP Claims processing Claims Complexity
- 2. © FIRSTSOURCE 2023 | CONFIDENTIAL | 2 ComprehensiveClaimsExperienceAcrossPlanTypes,ClaimTypesandPlatforms Plan Type Claim Type Applications • Commercial • Medicaid • Medicare Advantage • Medicare supplement • Marketplace • FEP • Dental • Vision • Facility • Professional • BlueCard (Home, Host, Transmittals) • Inpatient • Outpatient • DME • Home Health • SNF • ESRD • Behavioral • Rehab • Long term / Acute Care • Radiology • Cardiology • MSK • Labs • Ambulatory • Critical Access Hospitals • Emergency • COB • Dental • Urgent care • Pharmacy • Maternity • Office visits • Facets • QNXT • MHS Powerstepp • WGS • BlueSquared • Diamond • NASCO • Amysis • FEP Direct • RIMS • Macess • IDX • Paradigm • PowerQ • IMPACT • EBIX • Client Proprietary Systems • VIDASuite • Health Rules
- 3. © FIRSTSOURCE 2023 | CONFIDENTIAL | 3 ClaimsProcessingFootprint Claims Processing States Supported – Arizona, California, Florida, Idaho, Illinois, Kentucky, Massachusetts, Michigan, Mississippi, New Mexico, New York, Ohio, South Carolina, Texas, Utah, Virginia, Washington, Wisconsin, Georgia, New Jersey, Kansas, Louisiana, Maryland, Pennsylvania, West Virginia, Indiana, Minnesota, South Dakota, Missouri, North Dakota, Nebraska, Iowa Oklahoma, Hawaii Massachusetts Illinois Kentucky Florida California Mississippi Michigan Texas Virginia Arizona Idaho New Mexico Ohio South Carolina Utah Washington Wisconsin New York Present Across 34 States Georgia New Jersey Kansas Louisiana Maryland Pennsylvania West Virginia Indiana South Dakota Minnesota Missouri North Dakota Nebraska Oklahoma Iowa Hawaii
- 4. © FIRSTSOURCE 2023 | CONFIDENTIAL | 4 SuccessfulPartnershipswithHealthPlansDeliveringValueforClaimsOperations 2004 2003 2010 2006 Large Fortune 500 Health Plan A Regional Blue Plan • Local Host Professional and Facility BlueCard Claims Adjudication and record processing • NASCO - Professional and Facility claim adjudication • Enrollment – Commercial, Home / Host, Instate, PPO, HMO Managed Healthcare Plan • Claims Adjudication support for ~ 8.8 M Medicaid Claims per annum • Medicaid, MMP, MP claims for 15 states • Enrollment –834 Exceptions, Demographics An HMO and PPO Health Plan • Claims Processing, provider Loading, Handling of XC claims • FACETS - Provider and Member contact center services & Open Enrollment Support First Program Client Firstsource Services 19 Years 18 Years 16 Years 12 Years Partnership in Years • Digital Intake, Claims processing, Consumer driven Health Plans • Combined accumulation reconciliation process • Group Enrollment for groups > 100 members
