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Healthcare

Healthcare

Healthcare reform significantly transformed the healthcare sector. In order to meet the new business challenges while complying with regulatory requirements, your healthcare organization will need to redefine business strategies. In addition, you need to update your organization’s IT infrastructure to:

  • Improve Operational Efficiency
  • Reduce Costs
  • Provide Better-Quality Healthcare Services

At XL Softek, we offer leading-edge technology services and solutions to assist both healthcare payers and providers, as well as include a comprehensive suite of IT and Business Process Outsourcing (BPO) services. Our healthcare offerings help payers and providers overcome business challenges, comply with regulations and mandates, and stay ahead of the changing healthcare marketplace without incurring financial loss.

Next Levels

We look to take IT healthcare services to the next level by providing the following:

  • IT offerings to healthcare payers
  • IT offerings to healthcare providers
  • ICD-10 solutions

Healthcare Payer Services

Our IT offerings help healthcare payers overcome business challenges, including:

  • Delivering Healthcare Value
  • Meeting Regulatory Requirements
  • Increasing Operations Efficiency
  • Managing Risk
  • Enhancing Choices for Consumers
  • Cost Control

Improve Healthcare Value

  • Offering providers performance initiatives based on their healthcare performance (Cost-effective care and wellness programs)
  • Business intelligence and data analytics services enable you to identify high-risk members
  • Content management solutions help you develop case management platforms
  • Our partnership with IBM and MicroStrategy help develop and host enterprise solutions to support case, disease and utilization management

Seamless Regulatory Compliance

  • Our application assessment, remediation and testing services enable your seamless compliance with ICD-10 conversion and healthcare reform
  • Our flexible Service-oriented Architecture (SOA) framework and messaging services allow government and private entities to quickly set up and share knowledge in health information exchanges.

Increase Operational Efficiency

  • More focus on customer facing processes
  • Our adjudication services for medical, vision, pharmacy and dental claims coordinated with Medicare and Medicaid enables seamless and quick integrations with pharmacy benefit managers.
  • Our BPO services supports the following:
    • Claims Receipt
    • Scanning
    • Archival
    • Processing
    • Adjudication of pended claims
    • Status inquiry from members, providers and employer groups

Risk Management with Robust Utilization Review

  • Risk management with meaningful analytics for supply cost optimization, fraud detection and identification of cost-effective treatment
  • Our robust business intelligence and data warehouse services help you study utilization and manage underwriting risks.
  • Our partnership with Oracle enables effective data mining and development of solid analytical tools for financial, clinical and operational data, giving you a 360-degree view of your business.

Improve Consumerism

  • Enhances planning, managing and operating healthcare services by helping consumers select the right healthcare and insurance coverage.

Portals

  • Assists integration of web-based enrollment systems with your underwriting, membership and billing systems, ensuring a quicker, seamless experience for your customers.

Consumer-Directed Products

  • Our enterprise application integration services combine your claims and reimbursement processes with your banking vendors to support customer directed healthcare products and arrangements.

Healthcare Provider Services

We help healthcare providers overcome business and regulatory changes related to:

  • Patient safety and quality of care
  • Improving operational transparency and service levels
  • Enhancing consumer services
  • Meeting regulatory mandates like HIE and ICD-10

Digitization and content management solutions—Enables you to create Electronic Medical Records (EMRs), providing quick access to patient information.

Lab integration and record management services—Helps you maintain patient health history and treatment outcome records.

Revenue cycle management services—Helps you manage your financial inflows and outflows with accurate reporting, while providing insight on payment reimbursement permitting transparent business operations.

Data warehousing and analytics—Helps you evaluate resource utilization (doctors/support staff usage, bed utilization, average length of stay, etc) and monitor service levels.

ICD-10 conversion and testing framework—Helps expedite and complete the conversion effort.

Content management services—Allows easy and secure upload, as well as management of patient medical records into the HIE.

Our ICD-10 Solution Framework

ICD-10 migration tools and products promise comprehensive impact analysis and determinate crosswalks. Such products are generic, expensive and require additional work to customize it to your organization.
At XL Softek , we understand that there is not a “one size fits all” solution and each organization has its own unique approach to the mandate. We base our services on our deep understanding of the payer industry. We recognize that over 80% of the ICD-9 diagnosis codes cannot be mapped to a single ICD-10 code unless supporting clinical data is available
Determining the closest map also requires assessing codes for payment and clinical equivalence, with each payer differing in their assessment approach. We also understand that the ICD-10 mandate is one of the many top initiatives you are trying to balance. Our ICD-10 conversion and testing framework helps expedite and complete the conversion effort.