Healthcare Process Management
The business of insurers can be significantly impacted by the improvement of health claims processes. Efficient claims management not only enhances customer experience but also reduces processing costs and time, adjudication errors, and ensures increased regulatory compliance. To achieve these goals, Karma Global offers a cutting-edge Business Process Management (BPM) solution tailored for healthcare, assisting insurers and payers in transforming their claims management processes.
Karma Global’s BPM solution leverages the power of TruBot, an enterprise-grade multi-skilled robotic process automation (RPA) bot. Through advanced imaging technologies and document capture, along with the proprietary intelligent document processing solution, TruCap+, and rule-based algorithms, the system effectively mines context and intelligence from unstructured data. The result is minimized adjudication errors, reduced claims processing costs, increased efficiency, and a superior customer service experience for insurers.
For enterprises seeking to take full control and cognizance of monitoring and eliminating fraud in the claims processing, Karma Global BPM solution provides the answer. The platform incorporates Artificial Intelligence (AI) / Machine Learning (ML) algorithms to decrease instances of false positives and false negatives, thus improving processing time and turnaround time.
Payer Services
Mailroom & Scanning
- By leveraging intelligent document processing and RPA, this service expedites scanning and processing of paper-based forms, offering exceptional processing speed and accuracy to meet all payer requirements.
Claims Management
- This service encompasses claims registration, verification, settlement & disbursement, fraudulent claims management, and audit of claims management, thereby accelerating claim settlement procedures.
Claims Pre-Adjudication
- Through this service, claims forms are adjudicated with minimal errors and high levels of accuracy, thanks to AI / ML algorithms that reduce instances of false positives and false negatives.
Membership Management and Billing
- This service ensures complete automation of the data management system, facilitating new membership enrollment, renewals, eligibility checks, monitoring, and client billing.
Adjudication Services
- Facilitating faster settlements, this service lowers healthcare costs per claim, ensures cost reductions in data processing, and guarantees year-on-year savings.
Member and Provider Matching
- This service ensures accuracy in payments processing and facilitates direct payment to the account.
Sales & Underwriting
- Offering effective contract management, sales automation, quote and rate underwriting, risk classification, and pricing solutions.
E-Portal
- Providing interactive web portals to enhance member-provider engagement and interaction, along with a digital ecosystem to expedite claim processing and settlement.
Care Management
- Presenting user-friendly, Omni-channel care management that helps payers provide on-demand support to patients.
Provider Services
Revenue Cycle Management Services
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Facilitating a seamless transition from the traditional 'Fee for Service (FSS)' payment model to a more integrated 'Pay for Performance' model, with automated coding and insurance verification.
Payment Posting Services
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Covering the posting of payments received from health insurance payers/members towards the settlement of claims to relevant patient accounts.
CRM Services
Customer Information
- Maintaining updated records of patient information and related contact details, facilitating updating of interactions in the patient, payer, and provider ecosystem.
IVR Solutions
- Offering all patient communication on a single platform; automating the hospital's precision care workflows and guiding the patient with real-time data access.
Enterprise
- Karma Global provides services and software for quality management, regulatory compliance, and F&A management. Offering auditable and enterprise-grade solutions to meet the diverse needs of healthcare and insurance enterprises.