Business solutions for healthcare enterprises
Healthcare Payers and Providers have no choice: they must develop an information capability to compete, grow, and reduce operational costs while they advance their pressing business imperatives.
No matter your focus – from consumer engagement, care management, operational efficiency, to compliance and beyond – Ajilitee is the bridge between business and technology, with proven accelerators that improve speed to market and reduce project risk.
Business-focused services and workshops deliver measurable outcomes
Our strategy, workshop, and implementation services provide deep business insight, drive better decisions, enhance productivity, and improve the top and bottom lines. They are supported by a strong data foundation and enterprise-wide reporting and analytics.
Payment integrity initiatives are gaining recognition within health plans for the importance they play in managing margins to support the bottom line and meet medical loss ratio. From an assessment of your enterprise payment integrity initiatives, to evaluating performance and collaborating with vendors, Ajilitee has solutions to help. With an Ajilitee Cost Containment Checkup, health plans get an objective and insightful assessment of claims cost avoidance and recovery efforts across all areas of the organization. We measure and analyze all angles of a plan’s performance to identify opportunities to minimize claims costs, maximize recoveries, and increase productivity of recovery teams.
In addition to consulting services, we offer a Payment Integrity Dashboard solution, which enables full transparency and insight into the performance of the plan’s cost containment and payment integrity programs. Our dashboards, reports, and analytics provide you with powerful tools for evaluating performance, making more informed and objective decisions, and driving best practices.
Risk Management Assessment from Ajilitee provides health plans with an objective validation and assessment of the successes, challenges, and opportunities in their current risk management programs. We’ll help determine the steps needed to achieve an accurate member health risk profile that drives improvements to revenue management, patient care, provider quality, and much more. With Ajilitee, you’ll build a program to get full visibility into risk management across the enterprise; align quality of care with risk-based premiums; determine how inaccurate disease coding affects revenue; and improve member adherence, CMS compliance, and audit.
Information Management solutions address the need for accurate, current information to inform programs and evaluate success. Our information management services take a holistic view of information needs throughout the enterprise and develop solutions that deliver the right information to your business areas at the right time. We begin with a strategic foundation and then implement the data quality, governance, and master data management solutions necessary to create a broader view of information across the enterprise.
Provider Data Management addresses a tremendous problem area for Payers and a key reason why claims fall out of the auto adjudication process. Poor Provider data quality impacts Provider directories, claims processing/auto adjudication, network management, compliance and fraud detection. Read more>>
Eligibility Data Management creates cohesion and accuracy among disparate eligibility sources to avoid in downstream inefficiencies and excess costs due to confusion over primary health plan COB payment. Read more>>
Our consulting, services and solutions can help you use information to work smarter, faster and with greater agility.