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Radiant Services, LLC

Leveraging the full power of Accenture Health to drive operational and clinical outcomes for health providers and health payers.

The challenge

Need for better outcomes for patients, health providers and health payers through productivity and care innovation services

Health payers and providers must boost efficiency, improve patient outcomes and manage costs while navigating complex regulations. Technology innovation in healthcare requires a skilled clinical team working alongside this advanced tech. And, partnering with a global provider offering talent, infrastructure, and new approaches helps organizations deliver clinical outcomes and meet financial expectations.

How we help

Clinical Transactions

100M+ Clinical Transactions Processed to date

IRRA

100% IRRA pass rate

IRRA score

98% average IRRA score among clinicians

Decades of healthcare expertise

21+ years of healthcare sourcing experience

Clinical sourcing excellence

12+ years of clinical sourcing experience

Reinvention in action

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Transforming clinical appeals for quality and speed

We helped our health insurance client reinvent their clinical appeals while implementing gen AI assets to elevate USRN tasks and drive down handle time by 70%.

Uncovering millions in incremental risk adjustment revenue

We deployed our patented AI Chart Review asset to help our regional health payer client identify more than $17M in incremental revenue.

Conquering staffing issues while boosting patient outcomes

We helped our provider client scale a team for patient scheduling across calls, faxes, and emails. With a focus on quality and operational rigor, we improved call-answer rates by 40% and achieved a 96% quality score.

Radiant Services, LLC was formed in February 2012 via a joint-venture partnership between WellPoint, Inc (now Elevance Health) and Accenture LLP.  Accenture LLP acquired Radiant Services from WellPoint, Inc through divestiture in February 2014.

Radiant Services, LLC has been a wholly-owned subsidiary of Accenture LLP (the parent company) since February 2014. Radiant Services is an Indiana limited liability company designated to perform, amongst other duties, utilization management (UM) services on its clients’ behalf. Radiant supplies its client's access to a high-performance workforce that provide services from delivery centers located in Bangalore, India and Manila, Philippines.

Radiant Services, LLC, is a subsidiary of Accenture LLP.

Our partners

URAC Accredited logo Accredited NCQA Utilization Management logo

Radiant Services, LLC, was accredited by NCQA in Utilization Management.

Radiant Services, LLC, was accredited by URAC for HUM: Pre-Review Screening + Initial Clinical Review + Clinical Review Criteria Modular Accreditation 2.0 Accreditation Program.*

Please refer to your insurance plan's website via the links provided below for details about the utilization review plan, current pre-authorization requirements, restrictions and clinical criteria for medical necessity:

*NCQA has reviewed and accredited Radiant Services, LLC, Utilization Management functions only. For complete details on the scope of this review, visit The National Committee for Quality Assurance (NCQA).

Pharmacy Benefit Management

Complaints and Concerns

If you have a complaint about your pharmacy benefits, please email us at: radiant.compliance@accenture and include your name and contact information. A representative will contact you to gather additional information. We will review your complaint and respond within 30 days.

Formulary Exceptions and Continuity of Care

For Pennsylvania residents, see the Formulary Exceptions and Continuity of Care policies: Policy 1 and Policy 2

Tennessee Pharmacy Reimbursement Appeals — Initial Appeal Process

Radiant maintains an initial appeal process for pharmacy reimbursement and Maximum Allowable Cost (MAC) appeals in Tennessee, consistent with applicable law.

Deadlines

  • Submit appeal: Within 7 business days of the initial claim submission
  • Completeness review: Within 5 business days of receipt
  • Response to request for additional information: Within 5 business days
  • Final determination: Within 7 business days after receipt of complete information
  • Payment after approval: Within 7 business days (or 15 business days if rebilling is required)

Appeal Process (Summary)

  1. A pharmacy (or its PSAO/authorized representative) submits an appeal challenging reimbursement below actual cost and/or a MAC determination.

  2. Radiant records and reviews the submission for completeness.

  3. Radiant evaluates documentation and issues a written determination within required timeframes.

  4. If denied, the pharmacy may pursue an external appeal through the Tennessee Department of Commerce and Insurance.

How to Submit an Appeal

Radiant accepts the Tennessee Department of Commerce and Insurance standard pharmacy appeal form.

Tennessee Applicability

This initial appeal process applies to all prescription drugs or devices in Tennessee for which a pharmacy alleges it did not receive its actual cost.

Our leaders

Nizar Sajan

Managing Director – UShnps & Radiant President

LinkedIn

Tejash Shah, MD

Managing Director – Global Health Global Lead Care Reinvention

LinkedIn

Jena Schevitz

Health Operations, Global Offering Lead

*Radiant Service, LLC is a subsidiary of Accenture LLP