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PayerFusion is dedicated to assisting healthcare payers by providing effective cost containment, claims management and administrative solutions.
We Are:
Experts in reimbursement guidelines, coding standards, network development and payment Thought Leaders providing clients with guidance and forward thinking approaches to structuring policy and claims models for non-USA companies and domestic self-funded employers Innovators advising clients on best practices for preserving premium ratios and competitive advantage.
Overview
We are a client-focused organization structured to quickly respond to client business requirements and support the highest level of accountability and transparency.
Our Mission:
Achieve maximum reductions and discounts on billed charges by utilizing proactive solutions and fully compliant services Streamline the policy administration process and reduce client administrative expenditures
Solutions Our solutions are fully customizable to meet the needs of our clients as they adapt to the changes of the US healthcare industry. We Utilize:
Proprietary Provider Network with a zero-balance billing guarantee Technology Solutions to facilitate efficient & accurate claims administration as well as transparency and access to information. Cost-Plus Methodology that bases reimbursements on the actual cost of services- not on an inflated retail price. Forward-thinking approach that connects our knowledge and vision for the future of healthcare into proactive policies and procedures. Total Quality Management & Six Sigma Structure
Services
Claims Management - Both efficient and accurate, our claims management services generate savings while reducing administrative burden.
Cost Plus Claims Reduction Network Affiliates Claim Analysis and Validation Fraud Detection Benefits Verification and Coordination Claims Processing & Provider Payment
Secured/Firewall Environment
Customized Batch Processing Zero Balance Confirmation Customized Explanation of Benefits to payer, client & member
Services
Services
Services
Reimbursement Methodology
All medical specialties are covered including neo-natal care, cardiac, serious trauma hospitalization, surgeries and more