The External Claims Editing application allows you to correct claims errors produced during the last batch run. Examples of errors could be an incorrect Subscriber ID, or a Provider ID entered for a particular claim was not found. When corrected, the claims are resubmitted automatically in the next batch run Environment software & Tools: OS :Windows 7/Windows Server 2012 R2 Databases :Oracle SQL Developer, Microsoft SQL Server 2008 Application/Tools : UiPath, Facets, Citrix, WebBased, Microsoft Office.

C&S Eligibility is the process of assigning the respective plans and providers for the Members/Subscribers of different states. Process of aligning the providers,Eligibile plans is different for different states. Also, ID card , Notes needs to be generated for the members after the alignment. Environment software & Tools: OS :Windows 7/Windows Server 2012 R2 Databases :Oracle SQL Developer, Microsoft SQL Server 2008 Application/Tools : UiPath, Facets, Citrix, WebBased, Microsoft Office, Pre-tool.

Horizon BCBSNJ is the only licensed Blue cross and blue shield association plan in New Jersy Providing Insurance coverage to over 3 million people throughout New Jersey. The CareRadius Application Suite is a web-application which consolidates and organizes efficient collaboration among health plans, providers and members onto single, desktop version. Environment software & Tools: OS :Windows 7/Windows Server 2008 R2 Databases :Oracle SQL Developer, Microsoft SQL Server 2008 Mainframes :TPX (NMS - RCOE), NASCO Application/Tools : Blue Prism, IBM Clearquest, Horizon Service Now, Careconfig, CareManage, ITSM.

SourceOne offers a variety of innovative and cost effective healthcare payer solutions that are designed to align with our Blue Plan customers and help them to achieve their business objectives and serve the needs of their communities. Applications : Oulook, SQL server Mgmt studio, Desktop application (SourceOne), BluePrism.

Provider Contracts and fee schedules as well as systems adjudication logic within the provider pricing structure are reviewed to ensure claims are paid in.. CareRadius integrates data from multiple sources and shares it between health plans, practitioners and members in realtime, enhancing clinical decision-making, improving workflows, and reducing administrative costs.

We automate process using RPA technology with the help of Uipath tool

Automating the process

Subscribers data handling