HLS for Payers
Claims Administration:
Provider Engagement & Credentialing:
Our solutions enable payers to engage with providers and streamline the credentialing process, reducing administrative burden and improving compliance.
Provider Network Management:
Sonata offers end-to-end solutions for managing provider networks, including contract management, claims processing, and performance assessment.
Revenue Cycle Management:
Our revenue cycle management solutions help payers optimize claims processing and improve financial performance, while reducing administrative overhead.
Business Process Improvement:
Sonata's business process improvement solutions help payers identify and eliminate inefficiencies in their operations, improving productivity and reducing costs.
Encounters & PDE Management:
Our solutions enable payers to manage encounters and PDE data, improving compliance and optimizing revenue.
MSP Validation:
Sonata's MSP validation solutions help payers identify and manage Medicare Secondary Payer (MSP) cases, ensuring compliance and reducing financial risk.
Pricing Management:
We offer solutions to help payers optimize pricing and improve financial performance, while maintaining compliance with regulations.
Financial Reconciliation:
Our financial reconciliation solutions help payers manage financial transactions and improve accuracy, reducing errors and improving compliance.
Claims Processing / Medicare / Medicaid:
Sonata offers end-to-end solutions for claims processing, including Medicare and Medicaid claims management.
Performance Assessment:
Our performance assessment solutions help payers track and measure performance metrics, identifying areas for improvement and optimizing operations.
Medical Management:
We offer solutions to help payers manage medical costs, including utilization management, disease management, and case management.
Risk Adjustment & Revenue Optimization:
Our risk adjustment and revenue optimization solutions help payers identify and manage risk, optimizing revenue and improving financial performance.
Policy Administration:
Member Retention & Recapture:
Sonata's member retention and recapture solutions help payers improve member retention and reduce churn, improving member satisfaction and reducing costs.
Membership & Enrollment Administration:
We offer end-to-end solutions for managing membership and enrollment, including eligibility verification, enrollment processing, and member data management.
Benefit Administration:
Our benefit administration solutions help payers manage benefit plans and optimize plan performance, improving member satisfaction and reducing costs.
Member Outreach & Care Coordination:
Sonata's member outreach and care coordination solutions help payers engage with members and improve care coordination, improving member satisfaction and reducing costs.
Sales and Agency:
We offer solutions to help payers manage sales and agency operations, including agent licensing, commission management, and sales reporting.
Rating and Underwriting:
Our rating and underwriting solutions help payers manage risk and optimize pricing, improving financial performance and maintaining compliance with regulations.
Financial Administration:
Billing:
Sonata's billing solutions help payers manage billing operations and improve accuracy, reducing errors and improving member satisfaction.
Cash Management:
We offer solutions to help payers manage cash flow and optimize financial performance, reducing costs and improving compliance.
Corporate Financials:
Our corporate financials solutions help payers manage financial transactions and improve accuracy, reducing errors and improving compliance.
Capitalization:
Sonata's capitalization solutions help payers manage capitalization and optimize financial performance, reducing costs and improving compliance.
Revenue Cycle Management:
As a comprehensive healthcare management service provider for payer organizations, we specialize in a range of revenue cycle offerings.
Our team has extensive experience in Utilization Management, Concurrent Review, Precertification, Retrospective Review, Appeals, and Denials.
We offer a streamlined process for managing and monitoring these crucial components of the revenue cycle, ensuring that our clients can improve cash flow and minimize losses.
In addition, our health tech solutions offer a robust Case Management solution that focuses on managing the entire care process for patients, from admission to discharge.
Our Disease Management program is designed to provide tailored care plans to patients suffering from chronic illnesses, helping to reduce hospital readmissions and improve patient outcomes.
Our Health and Wellness Products and Services are designed to promote a healthier lifestyle and disease prevention, offering patients the tools and resources they need to take control of their health.
We also provide Quality Management services that help ensure that our clients meet the highest standards of care, and our Clinical/Medical BI/Analytics capabilities provide a deep dive into the data, helping organizations identify areas of improvement and manage risk. We offer Medical Risk Solutions, including Stop-Loss insurance, to help manage financial risk related to healthcare claims. Our team also specializes in expanding current products or process improvements, providing interface/deliverables to hospital organizations, and helping payer organizations to achieve their goals and objectives.
