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 |
|---|---|---|---|---|
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.
