Payers (Insurance)

Helping Payers - Both, Private & State Plans

Our platform helps payers / insurance companies organizing the following processes more efficiently at a large scale: payer-provider inter-operability, full enhanced eligibility inquiry, screening programs & early detection of risk groups, patient relationship, medical documentation and their review, billing & claims processing, equity & transparency, policy sales. As a result, quality of service improves, client satisfaction increases and overhead costs decline. While we enhance the patient journey and make it seamless, we help Payers keep the claims ratio / loss ratio low. Platform allows automating processes that are currently mostly manual and human-based, therefore minimizing margin of error.

Payer (Insurance) Value Propositions

Equity & Accessibility

Improved Efficiency

Reduced Errors

Patient Satisfaction

Engagement & Conversion Ratios Grow by 10%-30%

Claims Overhead Costs Reduce By 35%

Instantaneous, Real-Time Access To Medical Claims

NPS / CAHPS Improve by 10-30 Points

We Bring Efficiency, Inter-Operability & Power Analytics

You Capitalize On Improved Service Quality And Reduced Costs

Improved Inter-Operability, Patient Service Quality & Reduced Costs

We connect everyone in the healthcare ecosystem, automate support & administrative processes and allow payers / insurance companies (both, private and state plans) to:

Digitalize and automate full eligibility inquiry at admissions, opening medical case / claims and their review
Have instantaneous access to each medical case and claim, upon its very inception and follow it online, in real-time
Start claims processing & analysis earlier, when the event originates, and follow it in real-time vs having the same information at a conventional weekly or monthly billing cycles, post-factum, when the case is completed
Reduce average review time per medical case / claim
Significantly reduce workload on call centers and back office
Reduce claims processing overhead & administrative costs
Obtain full analytics on medical cases, billing and claims, to improve claims ratio and improve provider relationship
Reallocate released time & resources on sales and underwriting
Reach out patients / subscribers directly, through pushing follow-up meetings in the system, or through direct messenger communication or direct in-app video communication
Enhance screening programs to allow early detection, lowering clinical risks and treatment costs
Reduce claims ratio / loss ratio

Shorter Medical Case Access Time & Claims Review Time

Instantaneous, real-time access to medical cases
Full digital review of medica cases
Real-time, digital approval of pre-authorizations
Shorter time needed for claims review and processing
No time required on analytics

Significantly Improved Client / Patient Satisfaction

Uninterrupted and seamless user journey
Super convenient and easy-to-operate user interface
Transparent environment with best-in-class search and compare features
NPS / CAHPS significant growth

Securely Storing & Reviewing

Documentation

Medical records
Lab test results
Radiology results (images)
Insurance documentation: insurance policy & plan details, provider lists, services & tariffs, minimal spend & co-pays, pre-authorizations, approved or rejected claims, etc.
Billing documentation: invoices, paychecks, etc.

Financials, Costs & Revenues

Increased private insurance sales and Medicaid premiums due to increased NPS / CAHPS
Decreased claims ratio / loss ratio due to reduced human errors and early access to medical cases
Free online brokerage: lifetime, no-fee sale of insurance policies in the platform & app
Reduced overhead costs on billing processing, claims processing, patient interaction and policy sales

Electronic Workflow, Pre-Authorizations & Claims

Automatic approval of standard pre-authorizations
Instantaneous review and approval of non-standard pre-authorizations
Online, real-time review of prescriptions, referrals, medical case
Telemedicine integrated
In-app interaction with patients
Online review and approval of claims and refund requests

Prescriptions, Medications

In-Store Eligibility Inquiry

Enhanced eligibility and plan inquiry inside pharmacies & drug stores
Access patients' ePrescriptions and there adherence reports
Unique medication substitution algorithms
Fully automated monitoring of adverse drug reactions & adverse drug events

We work with insurance companies to provide a seamless interface to their insured beneficiaries and subscribers. We enhance visibility into policy information, full plan details and navigate users seamlessly in what is normally handled by contact centers. The cross-border, cross-channel accessibility to information and ability to digitally interact with the providers and pharmacies have proven to be not only equity and accessibility booster but, also, a significant time saver and administrative cost saver as well.

Replicating rules and algorithms of the payers and insurance companies, adhering to the internal policies and integrating them into our digital journeys and platform unchanged, allows efficient utilization of policies and plan benefits for both, payers and patients.

Andromeda helps payers / insurance companies, in both, state and private plans, reduce overhead administrative cost, boost service quality and patient satisfaction level and significantly strengthen loyalty.