Sagility’s Payer Services empowers our clients to maximize the value of their operational spend, increasing quality of care, while enhancing productivity through robust solutions. Experience seamless coordination for efficient care delivery, enriching member lives across the healthcare system.
Enrollment, Billing, and Claims
Sagility redefines claims management for payers with insightful, end-to-end solutions. We have more than 23 years of experience handling claims of all complexities across all products and over 20 claims platforms. Our experience in plan build and benefit configuration across multiple products brings our all-round expertise to ensure higher claims processing accuracy. In addition, we manage enrollment and billing operations across multiple plan types. Our transformational solutions allow for optimizing efficiency, reducing inaccuracies, boosting timeliness, and enhancing member and provider satisfaction.
Provider Network Operations
Today’s payers are demanding a solution for the costly, high-stakes problem of unreliable provider data. Sagility addresses the issue head-on, turning the tide on member dissatisfaction, provider friction, administrative overhead, and regulatory penalties. Our solutions address key requirements of the No Surprises Act.
With Sagility’s Provider Forward™ platform, you will experience a holistic view of the provider journey and high-leverage touch points across recruiting, contracting, credentialing and data maintenance processes. It effortlessly improves the overall Provider Network Operations efficiency by over 35% with automation and intelligence.
Sagility makes it easy for members and providers to achieve a higher resolution through specialized talent combined with end-to-end Contact Center as a Service solutions, including speech analytics and omnichannel platforms. Our primary goal is to enhance both member and provider experiences by offering solutions that streamline customer engagement and foster a robust healthcare network. By prioritizing customer-centricity, we improve Net Promoter Scores (NPS) and enhance healthcare outcomes.
Amid a sizable number of regulatory changes, clinical business leaders are facing several complex issues including clinician availability, disruptions to patient care, and increasing complexity of clinical interventions needing more sound and evidenced processes. To deal with these changes, Sagility has proactively invested in a global service delivery model and fliexible, end-to-end solutions including our Utilization Management as a Service platform. Our globally distributed clinical workforce consists of 1,500 nurses and licensed clinicians, Medical Director oversight, automation, and a centralized governance model through our Clinical Center of Excellence (COE). We are URAC accredited for Utilization Management. Sagility mitigates industry-wide issues with solutions centered around value-based care outcomes.
Sagility’s solutions streamline claims payment processes, eliminating fragmented and disjointed procedures that often lead to payment inaccuracies. We look at each claim with a holistic approach, prioritizing our analysis based on the highest recoverable payment amounts. Our payment integrity solution is built with an innovative 360-degree view of claims assessment. These solutions include Data Mining and Claims Repricing, as well as Clinical Audits, working in tandem to create value in both pre and post-pay instances.