BPO & BPaaS SERVICES

Maintaining capital expenses in infrastructure, technology, and employees isn’t cost effective for many health plans. More frequently, health plans choose to outsource their business processes to drive down administrative costs and focus on what they do best-enabling better healthcare outcomes.


Catalyst’s Business Process Outsourcing (BPO) and Business Process as a Service (BPaaS) are focused on providing outsourced support for the functional areas within a health plan, all at a significant cost savings.


BUSINESS PROCESS OUTSOURCING (BPO)


Catalyst provides a US-based and full-service BPO that is exclusively focused on the needs of health plans. Payers can elect to fully outsource health plan functions or select specific areas for Catalyst oversight. Catalyst will also deliver services via the health plan’s existing technologies or those of Catalyst.


Our expertise include:


    • Product
    • Billing Entities
    • Members
    • Billing/payment posting
    • Rating
    • Billing summary/maintenance
    • Payment adjustments
    • Reconciliation
    • Billing report resolution
    • Check reconciliation
    • EFT reconciliation
    • General account reconciliation
    • Waiver reconciliation
    • Account balancing/controls
    • Capitation reconciliation
    • Taxes
    • LPI
    • Escrow
    • Fines
    • Financial reporting
    • PNL
    • SAE/IRS reporting
    • IVR contact intake
    • E-mail contact intake
    • Portal contact intake
    • A&G contact intake
    • HIPAA verification
    • Benefit verification
    • Eligibility verification
    • Claims status verification
    • Provider status verification
    • UM status verification
    • ID card requests
    • Other fulfillment requests
    • Member demographic updates
    • Correspondence reissues
    • Pre-enrollment calls
    • Issue tracking and resolution
    • Claim intake
    • Error/pend resolution
    • Par and Non-Par pricing
    • Medical claim adjudication
    • Dental claim adjudication
    • Encounter processing
    • Adjustment processing
    • Accumulator tracking
    • Capitation settlement
    • Reporting
    • Correspondences
    • Paper Claims Receipt
    • Sorting and Prepping
    • Imaging (OCR / ICR)
    • Prior authorization (referrals/authorizations) of designated healthcare services
    • Concurrent review activity
    • Retrospective review activity
    • Utilization of evidenced-based guidelines, policies and nationally recognized clinical criteria
    • Medical necessity reviews
    • Professional utilization management
    • Spend analytics
    • Cost containment
    • Authorization management (appropriate care, correct POS)
    • Case management
    • Disease management
    • Outbound/Inbound Call Center Support
    • Intake/processing of appeals and grievances within appropriate timelines (expedited vs. non-expedited)
    • Appeals and grievances case tracking
    • Acknowledgement/Resolution letters (timeframe compliant)
    • Print and mail (EOB’s, EOP’s, Letters)
    • ID Cards
    • Post-enrollment collateral
    • Document storage and retrieval
    • Paper Document Receipt
    • Sorting and Prepping
    • Imaging (OCR / ICR)

Catalyst has partnerships with many technology vendors in the industry – which means Catalyst can rapidly adopt the client’s native technology.


BUSINESS PROCESS AS A SERVICE (BPaaS)


In addition to meeting the outsourcing needs of the health plan, Catalyst can provide technology solutions that help health plans meet their unique needs. Catalyst offers technologies for:


  • Claims
  • CRM
  • Telephony (e.g., ACD, PBX, IVR, CTI and Workforce Manager)
  • Authorizations
  • Analytics/Reporting
  • Enrollment
  • Pricing
  • Value-Based Payments

When introducing new technology, Catalyst can take a modular approach to introducing single aspect of a technology (i.e., a new claims engine). Using this approach, the client gets a new technology that helps improve their business and the effect is both less expensive and less disruptive to the business.


If the client determines their current technology solution no longer meets their demands, Catalyst introduce a comprehensive technology solution and lead the implementation. Given Catalyst’s wide range of partnerships and decades of experience, there’s no technology platform that Catalyst cannot install and manage.



2353 S/b Broadway. Denver, Colorado. 80210
303-393-8818 | 800-903-9574 | 303-393-8838