Processes Processes Financial / Audit ManagementMajor Process Groups Business Processes
CoreBeneficiary Management Enroll beneficiary Assign beneficiary to a Primary Care Provider (PCP) or primary care unit Eligibility inquiry by provider Eligibility inquiry by beneficiary Preauthorization Provider Management Register/ empanel provider Provider agreement Premium Management Premium collection Claims Management Claims processing Claims status inquiry Claims dispute and appeals Claims adjustment and voids Accounting Payment to providers Accounts receivable Accounts payable
SupportiveCare Management Manage costs of catastrophic cases Identify chronic disease management cases Enroll into chronic disease management programs Monitor chronic disease management cases Utilization Management Utilization management Pharmacy benefits management (PBM) Provider Quality Management Provider quality management Actuarial management Provider rate Set premium Reserve fund management Medical Loss Manage medical loss ratio (MLR) Audit and Fraud Identify fraudulent cases Manage fraudulent cases
Manage space
Manage content
Integrations