Payer Solution

A payer (or payor) is a company that manages a patient’s eligibility to enroll and submit claims for administrated medical services. Typically, these companies include insurance carriers and Third-Party Administrators (TPAs).

Payers depend on complete and accurate data from their network providers. This information verifies that a provider is entered and updated into a payer’s healthcare system correctly. Correct information ensures that claims can be processed and accurate directories are published.

Payers require systems that:

  • Support the building of their provider networks,
  • Manage those network contracts across product lines,
  • Verify the accuracy of provider credentials,
  • Produce directories with NCQA-standardized data, and
  • Include backend integration for processing claims and payment.

 

Enter Fourleaf: a unified CRM that eliminates dual data entry, organizes a wide range of documents and data elements, and automates data collection leading to accurate contracts and credentials.

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Expected Payer Outcomes

Payers require processes and systems that improve profitability, grow networks, and ensure validated credentials. Some payers and providers devote more than 20% of their back office operations toward processing manual updates and materials. 

  • Reduce credential error resulting in denied claims
  • Reduce time to negotiate and sign contracts
  • Improve process to design, build, and manage networks and providers
  • Reduce contact and location errors
  • Reduce paperwork and payer information requests
  • Provide verified list of specialties 
  • Determine provider and specialty. coverage areas
  • Overlay SDOH factors with network design
  • Find the right providers for the right network and patient types

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