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Tricom Healthcare
Tricom Healthcare
Tricom Healthcare
Tricom Healthcare
Tricom Healthcare
Tricom Healthcare
Tricom Healthcare
Tricom Healthcare
Tricom Healthcare
Tricom Healthcare
Tricom Healthcare
Tricom Healthcare
Tricom Healthcare
Tricom Healthcare
Tricom Healthcare
Tricom Healthcare
Tricom Healthcare
Tricom Healthcare
Tricom Healthcare
Tricom Healthcare
Tricom Healthcare
Tricom Healthcare
Tricom Healthcare
Tricom Healthcare
Tricom Healthcare
Tricom Healthcare
Tricom Healthcare
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Tricom Healthcare

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Tricom\'s presentation on claims processing and data capture.

Tricom\'s presentation on claims processing and data capture.

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  1. <ul><li>Healthcare Services </li></ul>
  2. Health Insurance – Claims Processing Services A complete pre-adjudication solution Confidentiality Statement This document is being submitted by Tricom Group on the understanding that the contents will not be divulged to any third party without the prior written consent of Tricom Group.
  3. <ul><li>Established: June 2000 </li></ul><ul><li>Annual Billings: $18 million + </li></ul><ul><li>Personnel: 2,500 + </li></ul><ul><li>ISO 9001:2000 certified </li></ul>About Tricom Group <ul><li>ISO 27001:2005 certified </li></ul><ul><li>HIPAA Compliant </li></ul><ul><li>Onshore and Offshore Service Delivery Capabilities </li></ul>Scale Experience Results = + + Don’t just outsource it... Smartsource it ISO 27001 Certified HIPAA Compliant
  4. Healthcare Claims Processing Service – An Overview Don’t just outsource it... Smartsource it ISO 27001 Certified HIPAA Compliant
  5. Don’t just outsource it... Smartsource it ISO 27001 Certified HIPAA Compliant Healthcare Claims Processing Service – An Overview
  6. <ul><li>Domain expertise in healthcare claims forms processing </li></ul><ul><li>Mail Collection: high speed opening, extraction and batching </li></ul><ul><li>Image capture on receipt </li></ul><ul><li>Multiple Capture Options: bar code, OCR and KFI </li></ul><ul><li>Domestic or Offshore Processing </li></ul><ul><li>Customization process to meet client requirements </li></ul><ul><li>Client-specific logical editing and data validation </li></ul><ul><li>Secure data transfer of claims information in client-specific formats </li></ul>Why Tricom? Don’t just outsource it... Smartsource it ISO 27001 Certified HIPAA Compliant
  7. <ul><li>Proprietary claim workflow management system </li></ul><ul><li>SLA driven performance </li></ul><ul><li>Marquee group of satisfied clients – renewed multi year contracts </li></ul><ul><li>HIPAA Compliant; ISO 27001 certified infrastructure </li></ul><ul><li>State-of-the-art multi-location service delivery (onshore or offshore) </li></ul><ul><li>Extensive BCP: disaster recovery plans ensure 24/7 operations </li></ul><ul><li>Web-based trouble ticket resolution </li></ul>Why Tricom? Don’t just outsource it... Smartsource it ISO 27001 Certified HIPAA Compliant
  8. <ul><li>Domain expertise in healthcare claims forms processing </li></ul><ul><li>Mail Collection: high speed opening, extraction and batching </li></ul><ul><li>Typical forms handled HCFA – UB92 – Dental forms – Other non-standard claims </li></ul><ul><li>Online/Offline, EDI processes, Hybrid </li></ul><ul><li>Turnaround: 4 hours to 72 hours </li></ul><ul><li>In-depth Experience in EDI formats (ANSI 835/837, ANSI 4010, ANSI 4010A, ECSIF, NSF 2.0 to NSF 5.0, Interpretation of 997 acknowledgement file to fix the failed files at client system, etc) </li></ul><ul><li>99.5% + accuracy level </li></ul><ul><li>Platform independent processing </li></ul><ul><li>Ability to handle seasonal volume fluctuations </li></ul>Why Tricom? Don’t just outsource it... Smartsource it ISO 27001 Certified HIPAA Compliant
  9. Why Tricom? <ul><li>Transaction pricing allows assessment of cost savings </li></ul><ul><li>25 programmer systems and application development team provides continuous support </li></ul><ul><li>Current capacity exceeds 50,000 claims per day with ability to ramp up at short notice </li></ul><ul><li>Can increase employee level at short notice </li></ul><ul><li>Trainers and facilities provide new recruit training </li></ul><ul><li>Over 30MBPS bandwidth across facilities: provision to increase at short notice </li></ul>Don’t just outsource it... Smartsource it ISO 27001 Certified HIPAA Compliant
  10. Healthcare Claims Processing Service – An Overview Don’t just outsource it... Smartsource it ISO 27001 Certified HIPAA Compliant
  11. Our KFI Processes - Offline Don’t just outsource it... Smartsource it ISO 27001 Certified HIPAA Compliant
  12. <ul><li>Domain expertise in healthcare claims forms processing </li></ul><ul><li>Dedicated secure working area and team working for your claims </li></ul><ul><li>Backfill to cater to absenteeism / handling volume fluctuations </li></ul><ul><li>24 x 7 operations </li></ul><ul><li>Dedicated Project Management team </li></ul><ul><li>Multi-location processing to ensure Business Continuity </li></ul><ul><li>Redundant backbone and infrastructure </li></ul>Tricom Provides: Tricom Benefits Don’t just outsource it... Smartsource it ISO 27001 Certified HIPAA Compliant
  13. <ul><li>Domain expertise in healthcare claims forms processing </li></ul><ul><li>Upgraded claims processing through data validation </li></ul><ul><li>Increased auto adjudication rates </li></ul><ul><li>Provider and member satisfaction through timely processing </li></ul><ul><li>Lower costs by eliminating multiple claims submissions </li></ul><ul><li>Access to complete onshore and offshore solutions </li></ul><ul><li>Offshore labor costs provide cost savings </li></ul>Tricom Provides: Tricom Benefits Don’t just outsource it... Smartsource it ISO 27001 Certified HIPAA Compliant
  14. Don’t just outsource it... Smartsource it ISO 27001 Certified HIPAA Compliant A Sampling of Clients
  15. Tricom Management Team and Organizational Structure Don’t just outsource it... Smartsource it ISO 27001 Certified HIPAA Compliant
  16. US Delivery Center 1: Phoenix, AZ <ul><li>Convenient locations </li></ul><ul><li>CMS1450 / CMS1500 </li></ul><ul><li>CLAIMS Medical Dental Pharmaceutical </li></ul><ul><li>CMS1450 / CMS1500 </li></ul><ul><li>NEW & OPEN ENROLLMENT Manual On-Line </li></ul>Don’t just outsource it... Smartsource it ISO 27001 Certified HIPAA Compliant
  17. US Delivery Center 2: Morton, WA <ul><li>Convenient locations </li></ul><ul><li>Paper Conversion Tiff PDF DjVu </li></ul><ul><li>Custom Indexing </li></ul><ul><li>Custom Retrieval Applications </li></ul><ul><li>Image Compression & Archiving </li></ul>Don’t just outsource it... Smartsource it ISO 27001 Certified HIPAA Compliant
  18. Global Delivery Centers - India <ul><li>Chennai </li></ul><ul><li>Mumbai (3) </li></ul><ul><li>Nasik Disaster Recovery & Business Continuity </li></ul>Facilities in India Five Locations: Don’t just outsource it... Smartsource it ISO 27001 Certified HIPAA Compliant
  19. Facility and Technical Resources <ul><li>Convenient locations </li></ul><ul><li>95,000 square feet </li></ul><ul><li>Fully Air conditioned </li></ul><ul><li>1,700 Pentium workstations </li></ul><ul><li>IBM and Dell Servers </li></ul><ul><li>20 mbps dedicated Bandwidth </li></ul><ul><li>CAT VI networking </li></ul><ul><li>VOIP US local numbers </li></ul>Don’t just outsource it... Smartsource it ISO 27001 Certified HIPAA Compliant
  20. <ul><li>Internal </li></ul><ul><li>LAN/Data access on need basis </li></ul><ul><li>Floppy and Optical drive, USB ports disabled </li></ul><ul><li>No personal baggage, cell phones allowed in the ops area </li></ul><ul><li>No Internet access, internal email or web mail allowed </li></ul><ul><li>No Printer access </li></ul><ul><li>External </li></ul><ul><li>High-end firewall </li></ul><ul><li>Secure VPNs </li></ul><ul><li>Restricted Internet access </li></ul>Facilities Security: Data Security Don’t just outsource it... Smartsource it ISO 27001 Certified HIPAA Compliant
  21. <ul><li>Security guards 24/7 </li></ul><ul><li>Controlled access to operations area </li></ul><ul><li>CCTC with DVR </li></ul>Facilities Security: <ul><li>Work flow restricts data access </li></ul><ul><li>Offline back of past data as per client requirement </li></ul><ul><li>Copying, imaging or duplicating data strictly forbidden </li></ul>Physical Security PHIC Don’t just outsource it... Smartsource it ISO 27001 Certified HIPAA Compliant
  22. <ul><li>Recruitment – A tested formula </li></ul><ul><li>Ongoing advertisements </li></ul><ul><li>Walk-in candidates </li></ul><ul><li>New hire referral program </li></ul><ul><li>Rigorous Selection & Hiring process </li></ul><ul><li>Resume review </li></ul><ul><li>Computer skills testing </li></ul><ul><li>Personal interview </li></ul>Human Resources Recruitment and Training Don’t just outsource it... Smartsource it ISO 27001 Certified HIPAA Compliant
  23. <ul><li>Security </li></ul><ul><li>Background and qualification checks </li></ul><ul><li>Nondisclosure and confidentiality agreements executed </li></ul><ul><li>Copy of passport/other government issued photo ID </li></ul><ul><li>Training </li></ul><ul><li>In-house trainers and content </li></ul><ul><li>Rigorous qualifying benchmarks </li></ul>Human Resources Recruitment and Training Don’t just outsource it... Smartsource it ISO 27001 Certified HIPAA Compliant
  24. <ul><li>Statutory Benefits </li></ul><ul><li>Privilege and casual leave </li></ul><ul><li>Provident fund </li></ul><ul><li>Medical insurance </li></ul><ul><li>Gratuity </li></ul><ul><li>Staff Welfare </li></ul><ul><li>Pick-up and drop-off service where required </li></ul><ul><li>24-hour cafeteria </li></ul><ul><li>Star Performer awards </li></ul>Human Resources Don’t just outsource it... Smartsource it ISO 27001 Certified HIPAA Compliant
  25. Next Steps to Engage Tricom <ul><li>Define Scope of Service </li></ul><ul><li>Feasibility study and requirement analysis </li></ul><ul><li>Contract / Letter of Intent Execution </li></ul><ul><li>Service level agreements and commercials discussed and finalized </li></ul><ul><li>Knowledge Transition </li></ul><ul><li>Initiate knowledge acquisition process in a manner convenient and unobtrusive to your daily operation </li></ul><ul><li>Ramp up / Ongoing Support </li></ul><ul><li>Complete execution of defined work utilizing full capacity </li></ul><ul><li>Reporting routine and critical information to authorized personnel </li></ul>Don’t just outsource it... Smartsource it ISO 27001 Certified HIPAA Compliant
  26. <ul><li>We’re a committed organization that Defines and Pursues </li></ul>STRONG VALUES AND GOALS VISION WITH SOLID GROWTH PLANS FOCUS AND STRATEGIC CLARITY PROVEN EXPERTISE DYNAMIC LEADERS AND ASSOCIATES
  27. <ul><li>Corporate Office </li></ul><ul><li>2450 Peralta Blvd, Suite 222 Fremont, CA 94536 </li></ul><ul><li>Tel : (510) 494-7800 Fax : (510) 494-7802 </li></ul><ul><li>www.tricominfo.com </li></ul>THANK YOU! Sameer Sheth Vice President North America Sales [email_address] Don’t just outsource it... Smartsource it ISO 27001 Certified HIPAA Compliant

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