Claims Management

Claims management is at the core of a TPA’s operations. HealthTigers offers a full suite of claims management services to ensure that claims are processed accurately and efficiently, minimizing errors and delays.

Claims Intake & Adjudication: Our team manages the intake of claims, reviewing and adjudicating them in accordance with your payer agreements and guidelines.
Claims Validation & Accuracy Checks: We verify that claims are accurate, complete, and comply with relevant policies and regulations before they are submitted to the payer, reducing the risk of denials or rejections.
Timely Payment Processing: We ensure that claims are processed in a timely manner, reducing the turnaround time for payments and improving cash flow.

Eligibility and Benefits Verification

Ensuring that members are eligible for benefits is essential to prevent claim denials and ensure accurate reimbursements. Our eligibility and benefits verification services reduce administrative errors and streamline the process.

Real-Time Eligibility Checks: We perform eligibility checks in real-time, allowing TPAs to confirm the member's coverage status before services are provided, ensuring the claim is processed without delays.
Accurate Benefits Verification: We ensure that the benefits and coverage information is correct for each member, minimizing the risk of billing issues.

Medical Billing and Coding

HealthTigers provides comprehensive billing and coding services that ensure accuracy, compliance, and efficiency. Our experienced coders ensure all claims are submitted with the correct ICD, CPT, and HCPCS codes to reduce the risk of rejection and ensure faster reimbursement.

ICD-10 and CPT Coding: We provide specialized coding services for all types of medical services, ensuring your claims are accurate and compliant with payer requirements.
Coding Audits and Compliance: We regularly audit the coding processes to ensure they align with industry standards and regulatory guidelines, minimizing the risk of audit penalties and claim denials.

Accounts Receivable (AR) Management

Efficient AR management is crucial for maintaining healthy cash flow. HealthTigers offers AR management services that ensure timely follow-ups and payment resolutions, reducing outstanding balances.

Aging AR Follow-Up: We proactively follow up on unpaid claims, addressing issues before they become problematic and accelerating the collections process.
Bad Debt Recovery: We handle overdue accounts and recover bad debt through systematic collections processes, helping to ensure that TPAs collect on all valid claims.

Reporting and Analytics

With our Reporting and Analytics solutions, TPAs can gain real-time insights into their claims processing and financial performance.

Customizable Dashboards: We provide real-time dashboards that allow TPAs to track claims status, payments, and outstanding balances, helping to identify trends and make data-driven decisions.
Data-Driven Insights: Our team generates actionable insights from claims data, enabling TPAs to improve operations, reduce inefficiencies, and maximize profitability.

Tailored Solutions for
Third-Party Administrators

At HealthTigers, we customize our solutions to meet the unique needs of different types of TPAs:

• Employer Self-Funded Plans: We assist TPAs managing self-funded plans to ensure accurate claims processing and payment, improving both client satisfaction and profitability.
• Insurance Companies and Brokers: We provide solutions that help TPAs working with insurance companies optimize their claim adjudication and payment processes.
• Specialty TPAs: For TPAs that specialize in areas such as workers' compensation or dental plans, we offer tailored solutions to streamline operations specific to those sectors.