Claims360
- Support Multiple Lines of Business
- Fully Integrated System
- Highly Configurable and Scalable
- Industry Standard Protocols
- Enterprise Data Interoperability with Internal/External Systems
Wipro's Claims360 solution with core administrative processing provides comprehensive support for members, providers, benefit plans, provider reimbursement and payment arrangements, claims, encounters, authorizations, and more for all lines of business and payers across the healthcare landscape.
Claims360 can automatically processes medical, dental and other ancillary claim types such a vision. The Medical claims include professional and institutional forms. Dental is also processed on its own claim form.
Claims360
Streamline workflows with a centralized, modern, core administration & claims management platform
Fully Configurable
Accurate, Simplified Rules-based, Parameter driven Configuration
Multiple Lines of Business
Medicare, Medicaid, Duals, Commercial TPA, Group & Individual, Delegated, International Specialty Insurers
Real-Time Editing & Processing
Real-time Editing, Auditing FWA. Updated 20+ Medicare Payment methodologies.
High Auto Adjudication Rate
Very High 1st pass Rates.
Flexible Benefit/Plan Design
Medical, Dental, Vision-Value Based, Supplemental, Tele-Health, etc.
Automated Workflows
Workflow Orchestration between Internal/External System
Business Benefits
Simplifying Healthcare Business with Enterprise payer platform
Benefits
Automation
Driving high auto-adjudication rates and minimizing the risk of paying claims incorrectly
Connect and
Communicate
Connect Health Plans to members, providers, and all essential stakeholders.
Enhance Provider
Network
Streamline workflow for Provider engagement and support multiple reimbursement arrangements
Lower
Utilization Rates
Data-driven utilization review, wellness services and monitoring/management of high-dollar claims.
Simplify
Workflow
Enterprise-wide efficiencies with end-to-end workflows for claims, Encounter data (RAPS/EDPS), and more
Transparency
in Compliance
End-to-end transparency and centralized premium and claim data