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Source HOV

New Delhi, Delhi

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Healthcare Payer

SourceHOV | Healthcare Solutions for Payers support the full spectrum of complex back office processes. Our 24X7 operations support many of the largest healthcare payer organizations in the United States.

Business Communication Services
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Business Communication Services from SourceHOV provides a convenient and cost-effective approach to manage print and mail with the innovative flexibility of merged physical and electronic communication delivery. We print and process more than 80 million pages and mail more than 25 million pieces per month. With more than 20 years of success serving our clients, including many Fortune 100 companies, SourceHOV has proven experience creating, printing, distributing and storing important documents such as statements, checks, notices and customer correspondence for all of the industries we serve. We work closely with our clients to create customized processes that prioritize mailing strategies and maximize communications programs.

Business Communication Services has five strategically located print and mail centers in the United States, so your communication is produced where it’s most advantageous to you. Each facility is SSAE 16 Type II certified and adheres to strict HIPAA security and confidentiality standards for an unparalleled focus on security and accuracy. We employ leading Transaction Processings and industry best practices in our robust, platforms-driven environment to provide postage, print and production cost savings, as well as better management of all types of business communications.

We offer a complete suite of electronic document distribution, remittance processing, and data file download services that can be incorporated into marketing program mailings, insurance solutions, and other Transaction Processinges. Our integrated print and mail solutions also include comprehensive database management, creating mailing lists that are current, functional and effective, and our clients can manage all aspects of their print and fulfillment online through our robust portal and simplified processes.

With a focus on speed and accuracy, the SourceHOV team secures our process-driven methodologies with thorough testing. We employ a team of more than 30 systems analysts and application developers, and offer the flexibility to work within our clients’ existing IT infrastructure to minimize high internal costs for you.

SourceHOV can provide your organization with a single source solution for:
  • Data composition
  • Data receipt
  • Data capture services and online presentment
  • Print and paper distribution
  • Print-insert mail and web-based document storage and retrieval
  • High-speed data printing
  • Intelligent insert
  • Mail processing and sorting
  • Print on demand
  • Personalized variable print capability
Industry Leading Production facilities

Our five fulfillment centers are capable of handling mission-critical documents containing very sensitive, personal information. Among the most technologically sophisticated production and distribution facilities in North America, they are equipped to handle the peaks and valleys in business volumes with SLA governed engagements, including next-business-day turnaround time. We can distribute workload across the facilities at a moment’s notice to provide business continuity in case of weather delays. Additionally, each facility is supported with an uninterruptable power supply and onsite, free-standing generators. Our clients benefit from balanced workload processing and peace of mind knowing the mail will be produced without exception.

The SourceHOV print and mail process is designed around the Integrated Document Manufacturing Facility (IDMF), which provides standardized yet configurable modules to quickly support intricate client-tailored output applications:

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Data Breach Solutions

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When a data breach occurs, the communication of timely and accurate information is crucial. At Rust Consulting, a SourceHOV company, we help our clients respond not only with seamless fulfillment, but with professionalism, empathy and dependability.

Rust has the in-house talent and systems to simplify and accelerate the implementation of a breach response for our clients. From avoidance and preparation through response, Rust can be a seamless and flexible component of your incident response plan by providing a comprehensive solution, either in lieu of, or as a supplement to, your existing capabilities.

Breach Response

We offer clients immediate, expert response services, including project management, virtually unlimited capacity notification services and contact center services.

Call Centers

We can establish a dedicated toll-free telephone line and Interactive Voice Response (IVR) messaging within hours after your initial call to us. Within days, we can train and staff a call center with customer service representatives (CSRs) on the specifics of your situation. Our CSRs undergo background checks and routinely handle sensitive information accurately and professionally.

Our call centers in Minneapolis and Faribault, MN, support up to 800 CSRs, while our project management team will provide regular updates on usage and performance metrics that are tailored to your specific situation and needs.

Notification

We offer all types of customized and cost-effective direct and multimedia-based notices, including direct mail, email, television, radio, newspaper and internet-based notice programs. We tailor every individual strategy based on each customer’s situation and budget.

We also develop and host customized website solutions that can be continuously updated to provide timely and accurate communication with your audience.

Data Management

Our team of technical experts will ensure that your customer information is accurate and well-structured to facilitate efficient notification and management of your contact with customers, and provide guidance on the most efficient and cost-effective methods for securely handling your data through the following services:

  • Affected customer identification and location
  • Database design and management
  • Manipulation of diverse types of files, formats and layouts
  • Consolidation of multiple records into one master list
  • Removal of duplicate records
  • Custom data processing
Security

Your information security is important. Our internal data security practices meet or exceed today’s demanding industry standards. A series of accreditations, audits and best practices that we call our unified compliance posture ensure that our data security practices protect the integrity of every engagement.

Breach Avoidance and Preperation

Rust Consulting can help you proactively prepare for a data breach. By including Rust in your breach avoidance plans, you’ll avoid downtime and administrative hurdles. We offer a master services agreement that allows us to be ready to support your organization with immediate crisis communication.

Experience

In our 35 years of experience, Rust has served leading corporations, government agencies and law firms.

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SourceHOV Claims Processing Services has over 25 years of industry experience and receive over 600,000 claims each day which are processed through our own proprietary technology platforms which offer our clients the most streamlined workflows and deliver some of the industry’s most accurate, secure and accelerated turnaround times.

  • 25+ years of experience with complex claims processing
  • Over 600,000 claims received each day
  • Proprietary technology platforms
  • Millions of business rules incorporated into our technology  platform
  • 27 different claim types processed; from simple to complex super bills

All these skills and capabilities allow SourceHOV to deliver some of the best performance metrics in the industry and in support of our Payer clients including:

  • Same Day turn-around time (TAT)  and accuracy  >99%;  often in less than 12 hours
  • Early claims status view – less than 24 hours from claim receipt
  • High auto-adjudication rate for paper claims – average  70%+
  • Reduced claims payment cycle to 24 hours from the initial 48 hours
  • Claims payment – averages less than 10 business days
  • Up to 50% reduction claims payment cycle time
  • Claims paid in first submission improved by 10%
  • Claims resolution rate at 98%, significantly above industry average
  • Up to 60% Reduction in Member Not Found (MNF) cases
  • Real time online reporting

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SourceHOV | Healthcare offers our Claim Overpayment Identification and Recovery Services to assist healthcare payers in identifying and recovering overpayments made to healthcare providers – monies that are contractually due your organization.

Using our proprietary contract management platform, our team of clinicians and experienced CPAs, we assist our payer clients by delivering a broad portfolio of post-payment reclamation support offerings. Clients have experienced revenue recovery ranging from $1 million to $10 million annually.

Working on a contingency basis, our fee is pay-for-performance based and is solely dependent on the monies or offset remittances identified and successfully collected from providers.

For Retrospective Overpayment Identification and Recovery, SourceHOV can:
  • Recover previously unidentified and unrecognized overpayments
  • Review adjudicated paid amounts for the most recent two to three-year period
  • Monitor past and future contract performance
For Concurrent Overpayment Identification and Recovery, SourceHOV can:
  • Review adjudicated paid amounts on a daily basis
  • Monitor all paid or to-be paid amounts, pre- or post-adjudication
  • Identify and pursue all overpayments at time of initial payment
  • Avoid timely recoupment limitations contained in provider agreements
  • Implement all new agreements and contract updates in a timely manner

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SourceHOV | Healthcare can use stored provider contract data to provide Payers with unlimited query and reporting capabilities for a wide variety of analytics and forecasting needs. This service is provided for a fixed monthly fee or a per report fee. We can provide: 

  • 835, 837 and provider agreement data enabling simple retrieval
  • All provider agreements are maintained for current and future access
  • All inpatient and outpatient provider claims
  • Reporting on any component contained in the 835 or 837 data sets
  • Immediate access to queries or reports
  • Fast and non-disruptive implementation, and no software or hardware costs.

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Document Lifecycle Solutions from SourceHOV can remove the challenges of managing physical documents and images, and will provide a roadmap to a completely electronic environment—increasing the efficiency of your internal teams and helping you provide greater service to your customers. SourceHOV has global experience helping our clients manage the full lifecycle of physical documents, from intake and conversion to temporary and archival storage, business communications and certified destruction for any type of text-, form- or image-based document.

Many businesses have evolved to a paperless environment for internal processes such as accounting, inventory, customer service, human resources and marketing. While these systems create efficiencies, enable faster communications and provide rich data to support business decisions, there is still a need to access physical documents and information that were created before the electronic systems or that come from clients in paper form. These hybrid physical and electronic environments create inefficiency and ultimately cost your business more to maintain. SourceHOV Document Life Cycle Solutions can remove the challenges of integrating physical documents into your electronic systems and provide your organization with a roadmap to an all-digital environment. Our solutions address the diverse environments that bring physical documents and payments into your electronic systems and the physical communications that can follow.

Documents and Data Security

SourceHOV maintains robust industry best-practice and regulatory-compliant operations to ensure the security of all the data and documents that we receive and process. In facilities that process sensitive documents, employees are not allowed to bring personal items into the workspace——protecting your documents by eliminating the possibility of any kind of recording or storage device entering our production environments. We offer more than 25 years of experience in providing critical Transaction Processing programs to numerous private organizations and federal, state and local governmental agencies that are subject to strict regulatory and legislative requirements, including SSAE16 Type II, SOX, PCI, HIPAA, FISMA, NIST, NARA, and FIPS.

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SourceHOV is one of very few firms certified and able to offer state-of-the-art records storage centers in full compliance with the latest National Archives and Records Administration (NARA) standards for record storage. Our facilities are available to government agencies and their vendors, and other entities who seek the highest level of security for offsite records management.

NARA’s rigorous security and record protection requirements apply to all government agencies and vendors. According to NARA’s Title 36 Code of Federal Regulations (CFR) part 1234, subpart B, federal agencies and the businesses that serve them are required to ensure that records in their legal custody are stored in an appropriate space as outlined in the Code. If current storage does not meet updated standards, agencies are responsible for transferring the records to NARA-compliant storage.

These strict requirements apply to all Federal records: books, papers, maps, photographs, radiological images or other documents made or received by an agency of the United States Government under Federal law or in connection with the transaction of public business. Companies and agencies which transfer records to a commercial records storage facility must guarantee that the facility meets all of the requirements of the sub-part of the Code. SourceHOV supports these requirements by providing all documentation required by NARA prior to transfer, ensuring the compliance of their records management protocol.

We provide comprehensive document management services for both e-records and hard-copy records. Our record management services also include confidential destruction, inventory, reports, and electronic record conversion, scanning and repository.

Being responsive to the records management needs of the Federal government and other highly regulated entities has been our focus for the 40+ years we’ve served businesses. As industry leaders in this category, our commitment is to our clients to provide superior storage solutions. We are dedicated to regulatory compliance, and our services meet all standards for security and storage management protocols.

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SourceHOV | Healthcare has successfully partnered with many of the largest healthcare payers in the country to deliver Plan Establishment and Member Enrollment Services.

Our solutions are flexible and range from serving as a replacement to your in-house operation or supplementing your current back-office operations. Our staff is highly experienced in processing large volume enrollments, member updates, terminations and other related enrollment transactions.

Every day SourceHOV | Healthcare processes tens of thousands of transactions in   benefits and enrollments in a 24/7 operations environment.   We work closely with our clients to identify and anticipate cyclical production requirements and align our staffing levels and resources to meet our clients’ project needs. Our operations center locations bring regional advantages that contribute to our efficient and timely delivery of our solutions. All SourceHOV | Healthcare facilities have the ability to flexibly staff up, meet seasonal or permanent increases in volumes, and operate on a 24/7/365 basis.

Confidentiality and Security

SourceHOV | Healthcare assures our clients’ and their customer’s confidential and personal information is safeguarded. Substantial investments in physical and data security and compliance have been made to ensure that our facilities are fully HIPAA, SAS70 Type II, Graham-Leach-Bliley Act, and Sarbanes-Oxley compliant.

Built-in Redundancy

Our robust processing platforms integrate multiple layers of equipment, technology, and contingency procedures to ensure that your work can continue in the event of any disaster. We use redundancy protocols, including firewalls, load balancers, front-end web servers, RAID disk arrays with back-up internet connectivity and providers in our hosted Tier 1 data centers to ensure clients maximum uptime.

Timeliness

SourceHOV | Healthcare understands the time constraints faced by our clients’ information-intensive organizations and the importance of processing their work in a timely manner. Our robust operational capacity allows us to support a wide variety of turnaround times to meet our clients’ business requirements.

Plan Establishment and Contract Loading

SourceHOV can increase auto-adjudication rates and accuracy to impact both efficiency and cost.  We build standard fee schedules, load insurance contracts, set fees, and compare and enforce insurance contracts. We are also able to increase accuracy of payments and eliminate manual audits through customized workflow products to provide early view and concurrent reports, resulting in improved turn-around times and increased accuracy.

Provider to Plan Matching

Provider matching is one of the most complicated obstacles facing claims managers; a mistaken provider match can result in an incorrect payment. SourceHOV’s provider matching process uses sophisticated provider matching algorithms to improve accuracy and remove the cost and errors associated with manual matches. We continuously improve the quality of our insurance fraud detection services and offer a cost-effective solution for insurance companies. This can in turn improve payment accuracy, lower cost and shorten turn-around for claim operations.

Member Enrollment

SourceHOV can significantly improve turnaround times and data load accuracy by aggregating inputs from web, fax, paper, and electronic data interchanges from multiple sources such as brokers and plan administrators into our workflow platforms. Our platforms allow us to manage the processes, auditing and instantiation of new plans for our clients, and create the correspondence for members, brokers and benefit managers.

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Negotiating new agreements with providers is a complex and stressful process. Frequently, payers move forward with a new contract without having the ability or resources to analyze future impacts of the new agreement.

With SourceHOV’s Predictive Contract Modeling Services, payers can accurately calculate expected allowed amounts for current as well as future, provider agreements. Our analytics engine facilitates the creation of multiple contractual scenarios using the most recent full year patient data sets, and allows us to derive the total dollar and percentage increase or decrease impact. Our real-time re-pricing engine automatically calculates complicated payment terms and program rules, allowing users to see all contract and claims data at the click of a mouse.

Our robust payer eligibility and contract management system, takes into account all aspects of the provider contract, including provider demographic information, affiliations, credentialing, reimbursement/fee schedules, along with stop-loss calculations.

  • Accurate expected allowed amounts for current and future agreements
  • Multiple scenarios can be created utilizing the most recent full year patient data set
  • Identifies total dollar and percentage increase or decrease for current and future agreements
  • Option to choose a fixed monthly or per provider agreement fee.

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SourceHOV | Healthcare can provide payer clients with the ability to shadow or replace in-house contract management systems.  The key to our clients’ success lies in our ability to calculate, and post expected payments.  Our Contract Calculation and Adjudication Services also improve processes, drive down operating costs and enhance capture rates for all expected payments.  This service is provided on a fixed monthly fee or a per claim fee.

  • Calculate and/or post expected payments
  • Shadow payers’ existing in-house adjudication system
  • Scan and attach contractual agreements to each respective provider claim
  • Accommodates unlimited contract years for respective provider
  • Improve the accuracy of payments and monthly financials
  • Fixed monthly fee or per claim fee.

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