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© e4e – Confidential and Proprietary e4e Healthcare Services Comprehensive Solutions for the Healthcare Ecosystem.

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Presentation on theme: "© e4e – Confidential and Proprietary e4e Healthcare Services Comprehensive Solutions for the Healthcare Ecosystem."— Presentation transcript:

1 © e4e – Confidential and Proprietary e4e Healthcare Services Comprehensive Solutions for the Healthcare Ecosystem

2 e4e Healthcare Business 2 IT Enabled Services & BPM Offices in 3 Countries 2750 + Employees Globally Work with over 6000 Physicians & 191 Hospitals Headquartered in Towson, MD, e4e Inc. is a growing, profitable, zero debt and a financially strong company. Our global delivery platform leverages a “right-shore” business model executed from 4 operational centers located in the US, India and Philippines. With over 21 years of rich experience, e4e carries a strong heritage of providing end to end Healthcare Services – through our Technology Platforms and Software IP. A cross-border Healthcare Company with proprietary Software Platforms for Revenue Cycle Management, Claims Processing, Audit and Process Automation. Technology agnostic solutions – experience in working with over 30 Provider and multiple Payer Platforms. Expertise in System and Platform Integration – System Interface, Electronic Data Inter-change and Workflow Efficiency. We process over 135 million transactions annually and code/ audit over 30 million charts. HIPAA Compliant systems and processes, e4e is also ISO 9001:2008 Certified, SOC – II and SSAE 16 Type II Compliant Company. © e4e – Confidential and Proprietary

3 Our Vision, Mission & Values e4e Vision e4e Mission e4e Values To be the Best-in-Class Business Process Management Company in the US Healthcare domain. To build, nurture, and strengthen bridges between our Clients and their Customers, by using legacy and new technologies and to deliver innovative, value-added performance outcomes that directly and positively impact our Client's businesses All about empowered people and a 'can do' attitude. For and because of our Clients. Powered by purposeful innovation, guided by unquestionable integrity. Committed to supporting the communities where we live and work. Driven by our core values of respect, trust, passion and commitment. © e4e – Confidential and Proprietary 3

4 e4e Healthcare Services © e4e – Confidential and Proprietary 4 Revenue Cycle Management Patient Access Management Charge Capture including clinical documentation improvement Claims, Remittance & Denial Management Hospital, Physician & Remote Coding HEDIS & DRG Coding Revenue Recovery & A/R Services Charge Integrity & Compliance Solutions Successful EMR driven billing service Dental RCM Payor Services Front End Claims Processing and Management Claims Adjudication and Error Suspense Resolution HCC Coding Services Enrollment Membership and Billing Services Customer Service Mailroom Service Grievance, Appeal & Refund Posting Reports Management Value Added Services Customer Support centers Business Rules Configuration Fraud, Waste & Audit Solutions RAC Response Management Solution for Providers Process Improvement Consulting for Physicians Ancillary Services for Payers Business consulting Analytics Technology Solutions Claims Administration Platform Scheduler Workflow Solutions including OCR ICD 10 Transition Support Document Management System Client Service Portal Member Portal Managed Services - Network & Desktop management

5 Patient Access Management Billing Medical Coding Denial Management A/R Follow up Hospital Service Offerings Scheduling & Registration Eligibility & Benefit Verification Data Entry Cash Posting Credit Balance Report Outpatient Visits Clinic Visits Emergency Department Same Day Surgery Inpatient Weekly review to check on denials Account Receivables Service Insurance Follow Up Increased Productivity, Faster Payments, Decreased Costs & Enhanced Patient Service © e4e – Confidential and Proprietary 5

6 Provider RCM Services © e4e – Confidential and Proprietary 6

7 Payer Services Member Management Claim Management Utilization Management Support Grievance Handling & Refund Posting Configuration Support Application Entry Generate CMS file like BEQ, MARx Work on response file like TRR, MMDD etc Disenrollment Processing Premium Billing Member Appeals & Grievances Handling Data Reconciliation Medicaid Verification PCP Assignment Provider Termination Generate Letters Referral/ Authorization Loading Indexing Medical Documents Temporary Provider Addition Contract Loading Fees Schedule Uploading Benefit Loading Maintain Master’s Receipt and Records of Appeals Analysis of Appeals Process Payment for favorable cases Generate provider letter if original denial is upheld Refund Posting Offset Posting Direct Data Entry of Claims Working EDI fall-outs Audit of Data Capture Member Validation Benefit Validation Fee Schedule Validation Audit of Processed Claims Generate check file & EOB Front End Rules Application & Data Verification © e4e – Confidential and Proprietary 7

8 Value Added Services Consulting Services for Front & Back Office Process Improvements Both Provider & Patient Support Call Centers Medical Policy Edits National Correct Coding Initiative Global Surgery Procedure-Gender Add On Codes Diagnosis-Gender Diagnosis-Age Multiple Surgery /Multiple Endoscopy Plan Benefit Configuration Provider Additions Provider Contract Uploading Fee Schedule Maintenance Rule Upload & Validation Pre-Emptive Audit Solutions Front End Edits CMS Audit Support HEDIS, RAPS Chart Audit MRA Chart Review, DRG Validation RAC Response Management including Trackers Customer Support Centers RAC Response Management for Providers Process Improvement Consulting for Physicians Ancillary Services for Payers Business Rules Configuration © e4e – Confidential and Proprietary 8

9 Delivery Strategy Best of Outsourcing outcomes with “Right-shoring” – a customized model that delivers better efficiency and savings © e4e – Confidential and Proprietary 9 Right- shoring Onshore- Remote Offshore US India Philippines

10 The Philippines – Why? Single-country risk diversification for e4e To take advantage of the resource pool – attuned to US culture, language etc To leverage the talent availability in the Healthcare domain – 18,000 registered nurses and 200,000 science under-grads The Philippines is known to have better US-English and accent skills, ideally suited for Customer Service/ Support, Self Pay, Collections, AR Follow-up and Coding domains With ICD-10 conversion fast approaching, additionally tap into the Coding talent, particularly for hospital and facility Coding Some of our Clients also wanted parallel service delivery from the Philippines 10 © e4e – Confidential and Proprietary

11 Highly Educated Human Capital American Cultural Affinity Services Industry Orientation The Philippines – Competitive Advantage Strong Govt. Support Robust IT & Infrastructure © e4e – Confidential and Proprietary 11

12 Contact Us © e4e – Confidential and Proprietary 12 Mihir Bhuta Vice President - CRM Mobile : +1 646 431 4540 mihir.bhuta@e4e.com Teresa Crawford Vice President - CRM Mobile: 214-289-9822 teresa.crawford@e4e.com Prakash SJ Sr. Manager – CRM prakash.sj@e4e.com Jason E Quandt AVP – Sales Mobile: 260-414-3373 jason.quandt@e4e.com Marvin Jones GM– Sales marvin.jones@e4e.com Charles Hatfield GM– Sales Mobile: 502-819-9909 (M) Charles.hatfield@e4e.com


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