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| Claims |
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| HIPAA requires that all health claims need to be maintained
in electronic data interchange (EDI) format. This has resulted
in TPAs and PPOs investing substantial time and resources in
converting the physical paper claims into HIPAA compliant EDI
format. This also requires sizable investments in technology
and infrastructure for this purpose. We are proficient in delivering
the HIPAA compliant ANSI 837 EDI claims. |
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| GURU CARE offers EDI conversion by using Manual Data Entry
of claims into GURU CARE's Workflow Engine. |
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| GURUCARE has developed expertise in data entry of the following
types of claims: |
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| GURUCARE's tested quality check policy ensures that the final
output to the client is delivered with high levels of accuracy
- two levels of quality check done - 100 % first level and 10%
random sampling second level. |
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| GURUCARE has also developed expertise and core competencies
on: |
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- Data Entry of claims in to the Claims System
- Re-pricing of Claims
- Pre-Adjudication Edits
- Adjudication
- Enrollment & Maintenance
- Provider Matching
- Provider Scrubbing
- Member Matching
- Provider & Facilities Database - Update & Maintenance
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| GURUCARE services offer the following benefits: |
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- Significant reduction in cost and increase in efficiency
and faster turnaround time
- GURUCARE bring in a strong work-flow infrastructure
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| Enables client to offload non-core activities and have greater
focus on Core activities. |
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- Increased accuracy of processed transactions
- Better leverage of existing infrastructure investments
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