In its Healthcare Payer services, Datamatics Technologies executes health claims processing for various payer groups and TPAs in the United States.

The Payer environment in the US is characterized by the fact times are tough, entities are cutting costs, budgets are getting squashed and investment appetites are low. Our proven onsite-offshore claims processing model relieves the payer groups of these pain points and helps them canalize resources onto more crucial business determinants like Policy Underwriting, Investigation for true-blue claims and Monitoring Quality in addition to revenue enhancing activities like Solicitation Campaigns and Relationship Management. In essence, we enable the payer groups to self actualize.

Our Service Scope

We process following types of health claims for the US customers:

	HCFA (Healthcare Financing Administration)
	UB 92 (Uniform Billing Code of 1992), Inpatient / Outpatient
	Dental
	EPSDT
	LTC (Long Term Care)
	Ambulance
	Medical Services

The service sequence that we provide is as follows:

	Claims collection process, through dedicated PO Boxes
	Document Preparation process comprising of Claims sorting in terms of claim types and types of their attachments followed by batching
	Scanning on a high speed scanner with a facility of red drop-out scanning
	Encryption of claim images and secured upload on the offshore FTP site
	Download, decryption & cropping of confidential claim information at offshore location
	Using customizable dual-capture method of OCR/ICR forms recognition and manual data capture, followed by comparison of these two distinct electronic records
	Ensure data caliber and authenticity by validating against client supplied ICD-09 (diagnosis codes), CPT04 (procedure codes), member unique ID and provider data
	Formatting data including HIPAA 837 format
	Generate exhaustive management reports, reconcile and upload to the client

Key advantages of outsourcing relationship with Datamatics Technologies:

	Experienced dual-shore project management: The seamless coordination between the experienced teams onshore & offshore provides smooth business transition with minimum or no disruptions
	Uninterrupted Service: Uninterrupted delivery of service for past several years due to adequate disaster recovery arrangements manifests the ruggedness of processes, resources and infrastructure
	HIPAA Compliance (for the US): We adhere to HIPAA compliance to ensure Security and Privacy safeguards, in line with the State and Federal guidelines (click the link for details on compliance)
	High Data Integrity: Our unique dual-capture methodology leveraging distinct advantages of data capture through human and OCR / ICR technologies, ensures an accuracy in excess of industrial standards in both financial and transactional components of data
	Flexibility in Handling Volumes: Our unique business model ensures that high volume fluctuations, a real pain point of a payer company, is absorbed without affecting the quality and turnaround SLAs
	Maturity in adopting technology: By virtue of being a part of 28 years old global IT solutions group company, we have mastered an art of embracing technology for suiting needs of automated claims processing

We currently process over 500,000 claims a month with adequate resources for expansion.

The US state protects confidential and classified Protected Health Information (PHI) through the law HIPAA (Health Insurance Portability and Accountability Act). The law details measures to be implemented by covered entities and business associates alike to achieve data security and administrative simplification in healthcare EDI transactions.

In our drive towards highly integrated execution of Healthcare EDI, we have in place a definitive security construct that protects PHI in the following dimensions:

	Volume — Enormous documentary volume treated with same exacting standards.
	Diversity — Multiplex file formats offered same levels of protection.
	Breadth — Covers the full spread of EDI across operator booths.
	Depth — Covers the entire intertwine of EDI with our business processes.

2. Privacy Safeguards {HIPAA Clause 164.504(e)(2)(ii)(B)}

What it means To insure consumer privacy, HIPAA regulations define standards for control of medical records and measures to restrict disclosure to minimum amount.

What we deliver Our security construct covers all levels of PHI security from the initial file-to-file connections in downloading to application-to-application interchange in the data processing.

I. HIPAA Security Official The official enforces and monitors security measures in our PHI processing. He maintains the required documents and reports, conducts drills and analyzes information. He ensures proper use of data, detects intrusions and is empowered to take corrective action. II. Auto Cropping and Encryption The auto crop program rips confidential field data from the PHI image. In encryption, each PHI is scrambled into unreadable, garbled characters using a 128-bit encryption that can only be opened by the authorized private key. III. Splitting of PHI We fracture the PHI into header (containing individually identifiable information) and footer (containing the health information). Each piece goes to a different operator so that no one operator has a united view of the PHI. One PHI piece in the absence of the other ceases to remain a security hazard and HIPAA compliance is met and exceeded.   Datamatics Proven Experience As the HIPAA compliance requirements evolve, Datamatics, as a Business Associate of covered entity would continue to reinvent its security policies and measures to meet the technology and physical threats. We would continue to meet and deliver our clients with foolproof, consistent and compliant healthcare EDI services.