Eligibility Checks & Authorizations, Medical Claims Transmission, Payment Collection & Reconciliation, Payment Denial Appeals

Digitally Streamlining Billing and Claims Processes for Healthcare Providers

We provide a comprehensive solution that fully automates billing and claims for healthcare providers, integrating with over 250 insurers for streamlined operations.

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The Problem We Attack

Health providers manually perform administrative activities of the financial cycle and this increases their costs, average collection period and causes revenue losses

High operating cost
Long average collection period
Revenue loss by term
Revenue losses due to human error

Problem statement

Insufficient interoperability between healthcare provider systems and payment sources leads to the necessity for manual work in standardizing and exchanging data between these systems. This lack of automated integration hampers accuracy in billing data exchange and results in revenue leakage.

Our Technology

Our technology solution establishes a direct digital connection between healthcare providers' HIS/ERP systems and payer entities, overcoming interoperability barriers.

This enables the automation of a wide range of administrative and financial activities that previously could not be automated.

In the Latin American healthcare sector, our technology plays a crucial role, managing 8% of the total invoicing for healthcare providers with carriers throughout Latam.

Our Platform

The iC-OS is a comprehensive and innovative operating system for the financial cycle in healthcare. It optimizes the hospital financial cycle by interconnecting healthcare providers and their payers, standing out for its high adaptability to various specific needs within the healthcare sector.

Eligibility Check & Authorization
The Eligibility Check & Authorization Module automates the medical authorization process from start to finish, streamlining eligibility verification and authorization password management. Key features include large-scale eligibility checks and password verification for medical procedures via integration APIs, enhancing operational efficiency and ensuring seamless patient service. This module integrates smoothly with the provider's ERP/HIS, supporting comprehensive automation for both eligibility verification and authorization password handling.

Payment Collection & Reconciliation

The Payment Collection & Reconciliation Module streamlines financial operations by automating the collection, matching, and reconciliation of payment data with medical billing, directly integrating with the provider's ERP/HIS. It stands out for its capacity to handle over 150 carriers and its leading market rate of automated reconciliation

Our automations work with over 250 carriers

Medical Claims Transmission

The Medical Claims Transmission Module streamlines billing in the provider's ERP/HIS by automating the creation and submission of billing XML and invoice files, supporting bulk operations, and feedback collection from multiple operator portals. It offers unique features like support for over 150 carriers, attachment sending, and off-schedule submissions.

Denial Appeals

The Appeal Module centralizes and automates the denial management process, offering large-scale analysis and automated appeal submissions to operators, integrating results into the provider's ERP/HIS. It supports over 250 carriers and allows attachment sending with denial appeals

iC-OS' Automation Map

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Our BPO Services

Payment Denial Appeal BPO

Our Payment Denial Appeal BPO service provides a comprehensive, outsourced solution for the operational management of payment denial appeals, ensuring:

Process Agility: We reduce the appeal resolution time for payment denials to up to 20 calendar days, speeding up the reimbursement process and optimizing financial flow.
Improvement in Quality and Recovery Rate: We improve the standard for appealing payment denials, increasing the average recovery rate by 20% due to a precise and well-substantiated approach.
Cost Efficiency: We achieve a 20% to 30% reduction in operational costs with our specialized team, allowing your resources to focus on other critical areas of your operation.

Reconciliation BPO

Our Reconciliation BPO service offers a complete, outsourced solution for the reconciliation of financial transactions, ensuring:

Operational Agility: We finalize the reconciliations and settlements of financial transactions within 72 hours after the posting of statements and credits.
Detailed Item-Level Reconciliation: Our reconciliation process exceeds the level of batch or global accounts; we focus on the details of each transaction, ensuring unmatched accuracy and a detailed view of financial movements.
Cost Efficiency: We provide a 20% to 30% reduction in the operational costs of the reconciliation team.

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Results and ROI

Our automation solution enhances back-office operations, streamlining payment collection and reducing revenue loss due to missed deadlines and human errors.

Up to 6% revenue recovery

Up to 30 days reduction in the average collection period

Up to 70% reduction in operating costs

ROI of more than 10x

This efficiency enables our clients to reclaim over $100 million annually.

Our clients recover over $100 million annually