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Home > Health Plans

HEALTH PLAN SERVICES

Healthcare is one of the largest industries in the United States and is constantly evolving. Perficient's dedication to process and quality improvement, cost reduction and consumer-driven healthcare helps payors to remain competitive. Our healthcare experience and business process modeling enable us to improve health plan operational performance, automate member management processors and boost overall benefit coordination and support. We focus on the seamless integration of plan and benefit coordination and user experience areas to more effectively run your organization.

Expertise

  • Health plan operational performance improvement
  • Process and quality improvement: Business intelligence, knowledge management, reporting, dashboards
  • Consumerization of healthcare and health plan models
  • Member, provider, sponsor/employer and broker portals
  • HIPAA, NCQA and CMS (Medicare & Medicaid) compliance
  • EDI integration (X12, NCPDP & proprietary)
  • Provider and member management services
  • Service carve-out coordination (vision, dental, PBM, behavioral health/EAP)
  • Perficient utilizes a comprehensive framework to assess organizations. Some of our solutions include: Project Roadmaps and Plans, Gap Analysis, Consumer Readiness Assessments (PEMMSM), Enterprise Software Selection (FIT2) and Systems Development.

     
    Perficient's 4010a - 5010 Upgrade Services
       
     
    Perficient's 4010a - 5010 Upgrade Services
    HIPAA requires the adoption of standards for healthcare organizations to use in electronic healthcare administrative transactions, such as claims, remittance, eligibility, and claims status requests and responses. The Department of Health and Human Services is mandating an upgrade from the current transaction standard X12 version 4010a, to version 5010 to be completed by 1/1/2012. This transition period begins 4/1/2009 and will require modifications across the industry. In order to be prepared for this change and the associated ICD-10 conversion, the time to take action is now.
     
     
    Read More
    Technology Enabled Process Re-Engineering
     
    Assurant Health Plan Portal Case Study
     
    Healthcare Solution Overview