The starting point for many payer organizations is a “current state” assessment of their operational infrastructure. For some payers and third-party administrators, an operational assessment could be limited to an examination of a specific function, such as member enrollment or stop-loss administration. For others, our skilled health care consultants can take a holistic approach, as detailed as desired, and report on any of the following topics:

• Claims processing (workflow and infrastructure)
• Cost containment and recovery
• Contract configuration
• Quality control and claims auditing
• Provider maintenance
• Utilization management
• Member eligibility and maintenance
• Coordination of benefits
• Compliance and inventory management
• Organizational structure and management
• Stop loss
• Training and development
• Benefit plan maintenance

After the assessment we provide a succinct written report (with both quantitative and qualitative results) to help you prioritize identified opportunities. We can also benchmark your current operations against industry best practices, meeting with you in person to discuss the results and answer any questions. In addition, we can facilitate responsiveness to the assessment by continuing to work with you to develop policies and procedures based on best practices or to reengineer functions as needed.