Solving today's challenges and laying the foundation of efficiency and flexibility for tomorrow.

Claims Support

Portico’s Claims Processing Support solution enables health plans to identify the right provider and the right contract – every time. Portico’s configurable provider selection logic adapts to complex provider organization structures and contract terms while increasing claims payment accuracy.

Key features:

Centralized, rules-driven, high-speed provider selection and verification
Flexible definition and management of provider selection rules
Automated contract fee schedule selection for pricing
End-to-end audit for provider selection and provider reimbursement
Drill down dashboards for reimbursement performance
Robust integration with claims systems

Key benefits:

Increased auto adjudication and claims payment accuracy
Decreased costs for reimbursement administration
Increased provider satisfaction
Increased speed to market of new products and contract arrangements
Decreased medical unit costs

Overview Recruiting Credentialing Contracting

Provider Information Mgmt.Provider Directory Provider Relationship Mgmt.Provider Self Service Claims Support Medical Home Clinical Data Integration

Events

Webinar: Optimizing Networks via Intelligent Provider Profiling

Webinar: Provider Information Management: Reducing Provider Administration Costs 10-25%

White Paper

A Shifting Tide in Healthcare Payer Application Assessments