WHEN IT COMES TO ENROLLMENT AND MEMBERSHIP MANAGEMENT SOLUTIONS
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1 WHEN IT COMES TO ENROLLMENT AND MEMBERSHIP MANAGEMENT SOLUTIONS You need to look no further! DO BUSINESS BETTER
2 ENROLLMENT AND MEMBERSHIP MANAGEMENT THE TRANSFORMING LANDSCAPE AND ITS IMPACT PPACA provides an opportunity to expand a payer s market share in managed Medicaid, medicare advantage and commercial insurance segments, but mandated medical loss ratio (MLR) asks for increased cost containment measures In the wake of minimizing customer churn, Healthcare payors are required to continuously innovate to improve benefit plan design, and deliver higher quality services so that they can improve STAR rating Key challenges faced by payers in such an environment are High risk of non-compliance mandated by federally regulated policy deliverance timeline (72 hours for 4Rx, 7 day deadline from enrollment completion to CMS transmission) directly contributing to star ratings of payors Potential revenue loss of 4-5%, especially if unable to handle seasonality affects (peak loads) due to ACA Additional infrastructure investments to handle different distribution channels (e.g., brokers, exchanges etc.) and complicated incoming enrollment data formats (fax, physical forms)
3 WINNING WITH WIPRO Wipro offers you a tightly integrated platform and services offering that provides real time eligibility and enrollment /membership management solutions, payment reconciliation and appeals/grievances handling for membership management. We will help you to - End customer experience Improve Customer satisfaction scores (CSAT) by Providing >99% accuracy across the process value chain Process multiple input formats (e.g., faxes and physical forms from brokers, EDI 834 etc. from different employers) Highly knowledgeable and domain trained customer support experts for handling appeals & grievances, enrollment & eligibility queries etc. 25+ years of fiscal agent experience 29 million eligibility queries processed per annum 98% First pass rate prior to CMS submission Cost efficiencies Reduce cost per enrollment by 10-30%+ to $3-$4, by delivering highly efficient enrollment process through multi-geography presence Tangible outcomesfor you Increased transparency: Provide 40+ reports and analytical insights to boost both operational and business excellence and increase STAR ratings Compliance: 100% adherence to HIPAA standards thereby avoiding penalty payout and increas ing star ratings; Certifications around ISO 27001:2001, BS7799 regular audits and robust FTE training 80,000 enrollment calls processed annually 444,000 managed care enrollments processed annually 500% increase in productivity across enrollment and premium billing Consistently provide 100% compliance
4 YOUR ONE STOP SHOP FOR ENROLLMENTS IS HERE Our comprehensive enrollment and membership management solution includes: A Enrollment & Disenrollment B Billing C Mailroom Receipt, entry, processing, transmission of enrollments (paper, electronic files, telephonic, web, group files, (complete, cancellations, reinstatements, and disenrollment s) Member maintenance TRR processing & reconciliation Letter generation Returned Mail (as high as 14-19%) Execute Subscriber & Group Premium Billing including paper electronic invoice Receipt, post and reconcile payments from SSA, ACH, Lock Box, Credit Card, MMR (LIS) Manage the delinquency process Premium Refund LIS/LEP for applicable members Manage Annual premium charges Inbound & Outbound mail (letters, fulfillment) Customer service and experience Revenue maximization D Reconciliation Monthly Reconciliation LEP (Late Enrollment Penalty) LIS (Low income subsidy) 4Rx (beneficiary specific Billing codes ) RPC (Retroactive Processing Contractor) Processing E Reconciliation Inbound & Outbound enrollment and billing Welcome Calls (new member)
5 WIPRO BPS BIZ RESULTS ACCELERATOR TM FOR MEMBERSHIP MANAGEMENT PROMISES TO DELIVER DISTINCTIVE BUSINESS IMPACT THROUGH SEVEN PILLARS CLIENT PARTNERSHIP MODEL TO DELIVER SUPERIOR CUSTOMER EXPERIENCE Clearly defined periodic performance review cycles between Wipro BPS and clients with support strong structure Global shared service model with presence in 12 countries DISTINCTIVE TALENT POOL BUILT ON DOMAIN AND OPERATIONS LEADERSHIP Deep domain expertise through 10+ Enrollment Specialists, PAHM certified SMEs with knowledge of HIPAA compliance 5+ Process consultants with end-to-end operational knowledge who are trained on various platforms FLEXIBLE COMMERCIAL MODELS TO ADDRESS CUSTOMER NEEDS Customized pricing models: Per member per month Per transaction Per FTE BPaaS INDUSTRY CENTRIC ANALYTICS MODELS THAT DELIVER BUSINESS OUTCOMES Diagnostic toolkit with industry benchmarks to identify areas of improvement across enrollments cycle $$ $$ 40+ reports (e.g.,: premium aging report) on M360 providing operational and business level insights; Core analytics on customer data for potential revenue generation opportunities Wipro BPS Biz. Biz. Results Results Accelerator Accelerator TM TM COMPREHENSIVE TECHNOLOGY STACKTO ENHANCE PROCESS EFFICIENCIES Comprehensive enrollment platform for MA - M360 (eligibility verification & enrollment platform) 100+ existing clients 24 million eligibilities processed annually 98% First pass rate prior to CMS submission 4 1 WIPRO BPS 3 2 PROCESS EXCELLENCE DELIVERED THROUGH OPERATION CENTRE OF EXCELLENCE 23+ years of fiscal agent experience with detailed multi-level process taxonomy Experience at key Mid West State in the US Proven delivery and performance track record, spanning 5+ Million enrollments in total e.g., 300% increase in productivity; 100% compliance INVESTMENT IN RISK AND COMPLIANCE EXPERTISE TO OFFER SECURED OPERATIONS HIPAA compliant process flow backed by certified CMS compliant risk managers Detailed repository of 50+ risk touchpoints with mitigation mechanisms R360 (Payment reconciliation) Over 60% process automated 50% reduction of FTEs Platform capabilities to service commercial and medicaid plans, via partnerships with leading platform provider
6 About Wipro Ltd. Wipro Ltd. (NYSE:WIT) is a leading Information Technology, Consulting and Business Process Services company that delivers solutions to enable its clients do business better. Wipro delivers winning business outcomes through its deep industry experience and a 360 degree view of Business through Technology - helping clients create successful and adaptive businesses. A company recognized globally for its comprehensive portfolio of services, a practitioner s approach to delivering innovation, and an organization wide commitment to sustainability, Wipro has a workforce of over 140,000, serving clients in 175+ cities across 6 continents. For more information, please visit DO BUSINESS BETTER CONSULTING SYSTEM INTEGRATION BUSINESS PROCESS SERVICES WIPRO LIMITED, DODDAKANNELLI, SARJAPUR ROAD, BANGALORE , INDIA. TEL : +91 (80) , FAX : +91 (80) , info@wipro.com North America South America Canada United Kingdom Germany France Switzerland Poland Austria Sweden Finland Benelux Portugal Romania Japan Philippines Singapore Malaysia Australia New Zealand WIPRO LIMITED 2014
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