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BSC Provider Operations.pptx

  1. © FIRSTSOURCE 2023 | CONFIDENTIAL | 1 Provider Operations Overview
  2. © FIRSTSOURCE 2023 | CONFIDENTIAL | 2 ProviderNetworkManagementCredentials 8 M+ Volume Processed Annually 9 Health Plan Clients > 99% in 2 Days Claims TAT 775 Experienced Associates 98% Accuracy of Provider Add/Term/Updates >99% Credentialing Data Accuracy 95% PDM TAT Compliance 98% Claims Fallout Accuracy 99% Fallout TAT Compliance Provider Fallout Management Provider Credentialing Demographics Setup and Maintenance Credentialing Application Process Primary Source Verification Provider Network Maintenance Provider Network Management
  3. © FIRSTSOURCE 2023 | CONFIDENTIAL | 3 ProviderServices Provider Data Services Provider Contracting Provider Calls Credentialing • Provider Add/Term/Updates • Provider Data Cleansing • Directory Maintenance • Claims Error Corrections • Provider Outreach • Provider Contract Loading • Re-imbursement & Fee Schedule Maintenance • Contract Testing • Eligibility & Coverage Inquiry • Prior Auth Inquiry • Claims Inquiry • Payment Inquiry • Benefits Information • Provider Outreach • Credentialing Application Process • Primary Source Verification • Provider outreach • Credentialing Compliance
  4. © FIRSTSOURCE 2023 | CONFIDENTIAL | 4 SuccessfulPartnershipswithHealthPlansDeliveringValue Large fortune 500 Health Plan A Large National Blue Plan A Regional Blue Plan Large Healthcare Intermediary Client Firstsource Services • Migration of their existing provider source of truth for Medicaid Line of business • Claims Error Correction - Updates to provider data from pended claims, outreach • Demographic Updates Add, Term, Updates • Provider Credentialing, institutional, professional and ancillary providers • Contract configuration Provider contract updates and fee schedules • Provider data management - Add, term, updates to provider demographic pricing and contract data • Provider Data Verification process and ongoing maintenance - Demographic, plan relationship and credential changes • Provider Matching - match provider information on claims that fall out from auto- processing​ • Data Cleansing for entire provider database to make it current​ • Credentialing Data Entry • Primary source verification and onboarding of providers, manufacturers & distributors India US, India US, India India Manila Healthcare Professional Network • Provider Data Management • Update Information Provider • Call Provider Offices and Validate data - demographics
  5. © FIRSTSOURCE 2023 | CONFIDENTIAL | 5 ProviderCredentialing Credentialing Initiation Application Support & Credentialing Inquiry Primary Source Verification Committee Prep Initial & Recred Physician Facility or Allied Dental Behavioral Vision Continuous Sanction Monitoring Compliance • Initiate Application Process • Run Re-cred reports • Provide Application Completion support • Credentialing Status • Verify Credentialing Elements • Outreach for additional info • Create Provider profile • Prepare for Credentialing Committee • Enrollment post Committee decision Demographics State License Education DEA/CDS Hospital Affiliation PLI NPDB/OIG/Opt-out Continuous Sanction Monitoring Initial - 20 Days | Recred - 100% Compliance
  6. © FIRSTSOURCE 2023 | CONFIDENTIAL | 6 ProviderDataServices Demographic Data Maintenance Plan relationship & Credential Changes Provider Add/Term/Updates Provider Data Cleansing Directory Maintenance Claims Error Corrections Managing Provider Directory entries and clean up of directory to improve accuracy Data Cleansing of the database to keep it current Resolve pended claims due to provider data Medicare Medicaid Commercial 95% within 10 Business Days Accuracy - 98% 95% within 3 Business Days Accuracy - 98%
  7. © Firstsource Solutions Limited | Confidential | Helping customers stay ahead of the curve through transformational technologies and capabilities Firstsource Solutions Limited, a RP-Sanjiv Goenka Group company, is a leading provider of transformational solutions and services spanning the customer lifecycle across Healthcare, Banking and Financial Services, Communications, Media and Technology and other industries. Our ‘Digital First, Digital Now’ approach helps organizations reinvent operations and reimagine business models, enabling them to deliver moments that matter and build competitive advantage. With an established presence in the US, the UK, India and the Philippines, we act as a trusted growth partner for over 100 leading global brands, including several Fortune 500 and FTSE 100 companies.