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CAPABILITY


Improving patient outcomes. Easy, right?

HEALTH BUSINESS PROCESS SERVICES

Healthcare management companies face a formidable mandate:
Build high-performing health management programs that improve quality of care and patient outcomes, keep costs under control and increase consumer and provider engagement.

WHAT WE DO

Accenture Health Business Process Services (BPS) help clients deliver on all counts by combining a cloud-based analytics platform with exception talent. We help payers, providers and government agencies drive breakthrough growth, increase customer engagement, improve health outcomes and reduce cost.

CLAIMS SERVICES

  • Claim edits, configuration testing
  • Claim suspends / pends adjudication
  • Adjustments, rework and correspondence

POPULATION HEALTH

  • Health risk assessments
  • Program enrollment
  • Health outreach (e.g., post-discharge calls)

UTILIZATION MANAGEMENT

  • Prior authorization intake and clinical review
  • Concurrent clinical review
  • Post-service clinical claim review and appeals support

PHARMACY BENEFITS MANAGEMENT

  • Benefits management and communication fulfillment

MEMBERSHIP SERVICES

  • Case installation and member enrolment
  • Contract development and benefits configuration
  • Premium billing, accounts receivable and reconciliation
PROVIDER SERVICES

  • Data maintenance
  • Credentialing support
  • Claim and provider service support

CARE VALUE

  • Member and provider outreach
  • Medical records retrieval and review

WHY WORK WITH US

Results Health BPS has delivered:
Applied analytics to increase on-time claim payments and improved cash flow by $13 million.
Applied analytics to increase on-time claim payments and IMPROVED CASH FLOW BY $13 MILLION.
Automation helped to strategically process claims, limiting late and inaccurate payments and avoid more than $15 million in penalties.
Automation helped to STRATEGICALLY PROCESS CLAIMS, limiting late and inaccurate payments and avoid more than $15 MILLION in penalties.
Helped a client to save nearly $140 million in total medical costs by using Accenture Advanced Health Analytics Platform.
Helped a client to SAVE NEARLY $140 MILLION in total medical costs by using Accenture Advanced Health Analytics Platform.
Reduced costs by $30 million per year, a 33 percent reduction, by scaling 1,000+ non-clinical and licensed nurses in the Philippines, India and US.
REDUCED COSTS BY $30 MILLION PER YEAR, a 33 percent reduction, by scaling 1,000+ non-clinical and licensed nurses in the Philippines, India and US.

IN THE SPOTLIGHT

WHAT WE THINK

WHO WE WORK WITH

WHO WE ARE

THERESA GAFFNEY

Health Business Process Services Lead
– Accenture Operations

"Sometimes businesses suffer from an operational illness. As diagnosticians, we see what’s wrong and know how to fix it. When we are in charge of millions of transactions or access points; we’re really at the heart of operations, so every second counts."

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