Our team of professionals brings years of expertise and experience in the healthcare industry, specializing in Healthcare Payer Solutions.
We tailor our services to meet the unique needs and goals of each healthcare payer.
We deliver excellence by leveraging technologies like automation and data analytics by improving efficiency and accuracy considerably.
Adhering to regulations and safeguarding patient information is in our DNA. We are SOC 2 Type 2, ISO-27001 certified, and fully HIPAA compliant. Our 100% work-from-office policy ensures highest confidentiality and data security.
At AMI, we specialize in co-managed operations that empower Healthcare Payers to overcome their most pressing challenges. By collaborating closely with your team, we deliver tailored solutions that address the complexities of claims processing, customer service, compliance, and data management. Our approach ensures seamless integration with your existing processes, helping you streamline workflows, optimize resources, and achieve your organizational goals with confidence.
Our staffing and operations expertise is crafted to help you reduce costs, enhance operational efficiency, and boost overall productivity. Backed by a team of highly skilled professionals, we manage the day-to-day tasks such as Medical Claims Processing Services that weigh you down, enabling you to concentrate on your core competencies and drive growth.
With a comprehensive suite of Healthcare Payer Solutions that include customer service, provider management, and end-to-end claims management, we bring unparalleled expertise and resources to meet your operational needs. Partner with AMI to leverage industry-leading practices, optimize outcomes, and position your organization for sustained success.
Policy Administration | Provider Information Management | Healthcare Data Management | Claims Processing | Health Insurance Analytics |
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AMI specializes in managing comprehensive membership enrolment and maintenance, ensuring seamless onboarding and continuous support for members. Our expertise in handling 834 EDI transactions guarantees accurate data handling, timely updates, and exceptional service, enhancing member satisfaction and organizational efficiency.
AMI excels in eligibility verification, providing accurate, real-time confirmation of patient coverage through 270/271 EDI transactions. Our streamlined processes minimize claim denials, reduce administrative burdens, and enhance revenue cycle efficiency.
AMI offers specialized verification services for pre-existing conditions and COB, utilizing industry-standard HIPAA 837 transactions to ensure accurate benefits coordination and prevent claim denials. Our meticulous approach optimizes reimbursement and enhances patient satisfaction.
AMI ensures up-to-date provider information management, maintaining accurate, current records in alignment with NPPES standards. Our expertise supports seamless communication, compliance, and operational efficiency, benefiting both providers and patients.
AMI excels in facility information management, maintaining accurate, detailed records of healthcare facilities per CMS guidelines. Our services enhance data integrity, support regulatory compliance, and improve overall operational efficiency.
AMI specializes in synchronizing provider directories, ensuring consistency and accuracy across all platforms, including CAQH ProView. Our solutions enhance accessibility, compliance, and patient satisfaction.
AMI offers comprehensive support for the credentialing process, ensuring timely and accurate verification of provider qualifications using NCQA standards. Our expertise streamlines operations, enhances compliance, and boosts organizational efficiency.
AMI specializes in healthcare provider contracting, negotiating favorable terms, and ensuring compliance with CMS and commercial payer requirements. Our expertise supports robust provider networks, optimal reimbursement rates, and efficient contract management. Using electronic signature solutions to eliminate physical document handling, such as printing, signing, scanning, and mailing. Digital contracts streamline the entire process by consolidating all contracts into a central repository, ensuring easy access, reducing duplication, and allowing for efficient tracking and updates. Automation of repetitive tasks like contract creation, approval workflows, and notifications to reduce manual effort and speed up the process.
AMI offers expert assistance in negotiating out-of-network claims, securing optimal reimbursement rates through UCR (Usual, Customary, and Reasonable) benchmarks. Our services minimize financial losses and enhance patient satisfaction.
AMI excels in fee schedule negotiation, ensuring fair, competitive reimbursement rates using RBRVS (Resource-Based Relative Value Scale) standards. Our expertise supports financial stability, compliance, and provider satisfaction.
AMI is an expert in loading provider contracts into payer systems using code groups, fee schedules, and provider contracting templates. This process ensures that the provider's information is accurately reflected for claims processing and reimbursement.
AMI specializes in medical claims data capture, ensuring precise and timely data entry and processing in compliance with ICD-10 and CPT coding guidelines. Our services improve claim accuracy, minimize denials, and optimize revenue cycles. We possess deep knowledge of CMS1500, UB04, and ADA Dental claim forms.
AMI offers expert claims adjudication services, ensuring accurate, timely claim processing through automated EDI 837/835 transactions. Our expertise minimizes errors, reduces denials, and optimizes reimbursement.
AMI excels in specialized claims processing, managing complex cases with precision and efficiency, including DRG (Diagnosis-Related Group) and APC (Ambulatory Payment Classification) claims. Our services enhance claim accuracy, reduce denials, and optimize revenue cycles.
AMI provides comprehensive appeals and complaints resolution services, ensuring timely, fair outcomes in accordance with ERISA regulations. Our expertise enhances patient satisfaction, compliance, and operational efficiency.
AMI specializes in payment integrity verification, ensuring accurate, compliant transactions through robust pre-payment and post-payment audits. Our services detect discrepancies, prevent fraud, and enhance financial integrity.
AMI offers expert risk adjustment factor services, ensuring accurate, compliant assessments using HCC (Hierarchical Condition Category) coding. Our expertise optimizes reimbursement rates, enhances compliance, and supports financial stability.
We schedule to speak in detail and understand your goals, challenges and current operations.
Depending on your volume & area of need, we decide on how many resources should we kick-off with.
We bring together our teams and set up a secure VPN channel & remote desktop that has minimum to zero latency.
We schedule for someone from your onshore team to virtually train our in-house trainer.
At this stage, the pilot batch is launched and the team starts working on the allocated accounts.
AMI ensures strict adherence to HIPAA regulations, backed by SOC 2 Type II, ISO-27001 certifications, and strict security measures. This includes encryption of electronic data, restricted access controls, regular audits, and employee training on ISMS. Additionally, stringent on-premises protocols include biometric login, CCTV monitoring, and disabling USB slots. Comprehensive training on handling PHI and HIPAA compliance ensures ongoing adherence among our skilled employees.
AMI's approach consists of employing strong security measures, including encryption protocols like TLS and AES, secure communication channels like VPNs or SFTP, RBAC for access control, DLP solutions, regular security audits, employee training, data encryption at rest, and incident response plan, to ensure the secure transmission of Protected Health Information (PHI) while adhering to industry regulations such as HIPAA. These measures collectively reduce the risk of data breaches or unauthorized access, enabling the safe exchange of PHI between clients and AMI.
AMI offers comprehensive training on handling Protected Health Information (PHI) and compliance with HIPAA regulations. This includes courses on confidentiality protocols, secure data handling practices, and regular updates on HIPAA guidelines to ensure ongoing employee compliance. Additionally, employees undergo regular assessments to reinforce their understanding and adherence to these critical standards.
Step 1. Pilot batch planning: Depending on your volume and the requirement, we’d mutually decide on a number of resources that should be allocated to your company.
Step 2. We get our IT teams together and we remote desktop into your system by using the provided Username-Password to log-in and begin working remotely (via a secure point-to-point VPN connection). This way the data stays in the US and everything is HIPAA and SOC 2 compliant.
Step 3. Training: Workflow training as per client’s software and existing process. The Pilot group is trained by the onshore trainer remotely via Virtual Training Platforms (Like GoToMeeting, Etc.), which also acts as a Train The Trainer Program, post which all future trainings are done internally by the designated AMi Trainer.
Step 4. Operations Knowledge Transfer: Understand the KPI's. Every client follows a unique strategy to produce better outcomes. Some clients concentrate on minimum ‘X’ number of closure percentage every month and some focus on touching every request as frequently as possible to get better rotation. At this stage, our ops team would understand the strategy and set up KPI's for the India team accordingly.
Step 5. On Job Training / Nesting: At this stage, the pilot batch is launched, and team India starts working on your orders. It is now time to observe their performance for the next few weeks.
Step 6. Pilot Evaluation: At this stage, a thorough evaluation of the Pilot is done based on our productivity and overall performance. The client would then proceed with signing a long-term agreement and adding more team members as in when required.
The pricing structure fluctuates based on the partner's specific business needs and the solutions sought following AMI's analysis of their operations. Simply schedule a call with AMI's sales team to learn more about their offerings
Generally, for the non-voice resources, most of our partners prefer for them to work during the nights in the US as it is daytime here in India, this enables them to save time and reduce the turnaround for their non-voice projects which are mostly based on the client's discretion. In terms of voice, these resources work in tandem with the state-side team, hence they work during the day in the US, and follow US time zones, based on the partner’s preference and on-shore location, they log in EST, CST, and PST, or MST hours. The resources also follow the same calendar followed by the state-side team and also take public holidays according to the US calendar.
AMI strongly believes in ethics and gives client privacy the utmost priority. Each client’s team is allocated a separate working space with glass partitions separating their teams from the rest of the floor. Measures are taken to restrict access to resources from sensitive information.
Yes, we do. We have a commercial general liability on an “occurrence basis” with a limit of not less than One Million Dollars ($1,000,000) & also, cyber liability insurance on an “occurrence basis” with a limit of not less than One Million Dollars ($1,000,000).
AMI collaborates with a diverse range of payers, including Private Health Insurance companies, Government Programs, MCOs, Employer-Sponsored Plans, Direct-to-Consumer Plans, and Specialty Health Plans that offer individual, family, and group health, dental, and vision insurance.
At AMI, we support a wide array of payers products, including Individuals and Family Health Insurance Plans; Employer-Sponsored Health Insurance (HMOs, PPOs, & EPOs); Medicare (part C, part D, Medigap); Medicaid Managed Care & Fee-for-service; CHIP; Short term & Long term Health Insurance; Dental & Vision, etc.
AMI does not have a direct partnership with any clearinghouse. We use the same clearing house that our partner clients use. In case you want to change or explore options we can make introductions and evaluate the same for you.
AMI’s Utilization Management and Care & Wellness Management enhance risk stratification processes, allowing more accurate identification of members with higher health risks. Through our enhanced data management and analytics, claims processing and accuracy, member outreach & engagement, cost management & resource allocation, clinical expertise, innovative solutions, compliance & quality control, streamlined operations, integrated care management, efficient process workflows, data security, and error reduction AMI helps improve the health risk profile of your covered population, ensuring better outcomes and resource allocation.
At AMI, we tailor our services to meet your specific needs. Depending on the volume some of our clients have one representative handling end-to-end claims process and taking both member and provider calls, and some have a more streamlined operation where the calls are queued, and dedicated resources are assigned for specific tasks to your Team-India at AMI.
Partnering with AMI can positively impact your HEDIS scores and Star ratings. AMI’s efficiency leads to efficient processing and handling of care management and patient outreach, accurate and timely data handling, effective follow-ups, and consistent outreach, and the high quality of service helps avoid errors and gaps to improve the HEDIS score. Maintaining high levels of responsiveness, care coordination, first-call resolution, consistent and effective member interaction and claims handling, and strictly adhering to compliance and regulatory guidelines and standards will help improve your plan’s star ratings and your NPS scores.
AMI’s member engagement services encompass Multichannel Support, 24/7 Availability, Quality Customer Service, Tracking & Resolution, Tailored Interactions, Proactive Outreach, Appointment Scheduling, Enrollment, EOB, etc.
Of course! By offshoring to AMI, you’ll reduce your operational cost substantially, allowing you to invest in member engagement initiatives, reduce premiums, or offer more services at the same premium. You can offer round-the-clock support enhancing customer satisfaction by providing access to assistance after your business hours. You’ll get access to AMI’s expertise and efficient process to improve the quality of support and easily handle the fluctuating volume for quick response time, leading to better member services.
With AMI’s enhanced member experience, you can expect a positive impact on member retention as well. The savings generated from offshoring with AMI can be reinvested into your offerings and member engagement initiatives, enabling you to increase your TAM and serve more lives.
Yes, we at AMI might use your APIs, our APIs, or third-party APIs, to access and process information seamlessly, through RDP and/or a secure VPN network.
The final decision on claims payments rests with you. AMI does not process claims payouts unless specifically requested. We suggest you keep control of claims payments to yourself.
AMI’s Claims Processing Accuracy, Member Communications, Customer Service, Analyzing Data and Feedback Mechanism, Streamlined Appeals Process, Claims Management & Grievance Management Systems, Collaboration between Teams, Proactive Member Advocacy, Performance Monitoring & Evaluation, and Continues Improvement have helped reduce Appeals and Grievances.
Yes, AMI offers Robotic Process Automation (RPA) solutions that assist in payer support services, enhancing efficiency and accuracy across various processes.
