Appeals & Grievances

Appeals & Grievances Solutions Appeals & Grievances When it comes to appeals and grievances, healthcare organizations are struggling to improve compliance, increase productivity, raise quality scores, minimize penalties, enhance reporting, and boost member and provider satisfaction. Our NCQA Accredited services deliver proven solutions to improve compliance and boost quality scores, such as 5-star ratings. By …

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OTC Services

OTC Services Solutions OTC Services Our Over the Counter (OTC) Services make it easy for your members to receive their medications and give your organization a turn-key solution for order generation, fulfillment, tracking and reporting. Your members can place orders via mail, phone or internet. All website integrations and call centers are customized to meet …

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MRA Services

MRA Services Solutions MRA Services We offer Medicare Risk Adjustment (MRA) services through our internally managed systems. Our systems are continuously updated to properly estimate what dollars are required for each member and conduct regular audits to ensure proper coding. We utilize complex algorithms to identify the most viable opportunities that yield the highest possible …

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Claims Administration

Claims Administration Solutions Claims Administration Beacon Health Solutions offers flexible, cloud-based claims processing and adjudication solutions for commercial, Medicare and Medicaid markets that reduce the cost of technology ownership and allows for rapid implementations. Through the use of our claims systems, our clients achieve greater levels of operational efficiency. On average we process 98.5% of …

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Compliance Consulting Services

Compliance Consulting Services Solutions Compliance Consulting Services Our compliance consulting services will guide you through your toughest obstacles. We provide an integrated framework that revolutionizes compliance processes. We speed reaction time with coordinated, multi-channel communications, intent-driven work processes, compliance reporting, real-time performance monitoring, and analytics to minimize risk. As information security professionals, we understand the …

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Enrollment Services

Enrollment Services Solutions Enrollment Services With the right forms and right services at your fingertips, you can reduce the time it takes to get your providers and members enrolled. Quickly merge provider information with Medicare, Medicaid, and other payer forms to fast-track the enrollment process. Our trained staff and systems can process applications, adjust coverages, …

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Medical and Quality Management Services

Medical and Quality Management Services Solutions Medical and Quality Management Services Cut cost and provide better care with our medical management services. Managing numerous requests for medical treatment within a network is a highly complex challenge with big implications for cost and effectiveness. Finding a value-based approach to utilization reviews that approve the right, evidenced-based …

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Fulfillment Services

Fulfillment Services Solutions Fulfillment Services In today’s world of data-on-demand, it is becoming more evident to healthcare payers that consumer expectations drive payer operations. To deliver responsive, transparent customer service, the most successful organizations are taking the progressive step toward providing, monitoring, and ensuring that consumer engagement takes place consistently over the course of the …

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IS Reporting

IS Reporting Solutions IS Reporting Beacon Health Solutions’ team understands the demanding requirements of today’s insurance industry and the importance of extensive reporting. Our reporting capabilities are second to none and allow for an expeditious flow of information. We also know how critical it is to protect data. Each client receives a dedicated server or …

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Member Communications Services

Member Communications Services Solutions Member Communications Services In today’s world of data-on-demand, it is becoming more evident to healthcare payers that consumer expectations drive payer operations. When it comes to delivering responsive, transparent customer service, the most successful payer organizations are taking the progressive step toward providing, monitoring, and ensuring that consumer engagement takes place …

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