Healthcare Payer Solutions

Powering the business of healthcare

 

Tackle the complexities of healthcare business with cost-effective, value-driven solutions

 

As a payer, health plan, IPA, ACO, MSO, or similar organization, you know that internal resource constraints and unresponsive vendors can hurt your bottom line. Don’t let these distractions hold you back. Instead, turn to SSI.

For over three decades, SSI has been the go-to source for EDI technology in the healthcare market, serving both payers and providers. But SSI is more than a technology provider; we are your partner in growth. Let us put our expertise to work to help lighten your load in terms of workforce and finances so you can focus on the heart of your business – serving your members!

SSI has the solutions to make doing business easier and more cost-efficient:

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EDI Services

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Enhanced Data Transaction

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IT Outsourcing

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Clearinghouse Services

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Paper Conversion Services

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Payer Communication Hub

EDI Services

SSI has a long-standing track record of processing EDI transactions – handling nearly 1 billion transactions annually and servicing over 3,500 distinct health plan connections. From Claims and Eligibility to Status and Remittance, SSI is one of the industry’s largest institutional providers of services.

At SSI, we aim to exceed your expectations at every turn. We pledge to deliver more. We equip you with advanced, sophisticated editing capabilities and a high-caliber quality of data integral to your business operations. Furthermore, we are committed to ensuring a smoother, more streamlined implementation process, minimizing disruptions to your workflow.

Benefits

  • Unified connection: Establish a single connection to the U.S. healthcare ecosystem for both administrative and clinical data
  • Claims simplification: Simplify the claim standardization process and gain the ability to receive claims in any format from any submitter (e.g., institutional, professional, and dental), clearinghouse, or billing company
  • Clinical data acquisition: Acquire clinical data, lab results, ADTs, EMRs, and more
  • Flexible edits and business rules: Change edits and business rules on your timeline, usually within 24-48 hours of a request
  • Paper volume reduction: Reduce paper volume with a system that works with your network to manage paper-to-electronic claim conversion

Featured Solution: SSI’s Managed Payer Gateway removes the complexity of paper and EDI transaction processing by establishing a single, streamlined connection of all inbound transactions. Customized to clients’ business rules, edits, and validations, the solution enables organizations to receive claims in the exact format necessary for their system to auto-adjudicate, regardless of the format in which they were submitted.

Enhanced Data Transactions

Health plans are embracing electronic attachments and authorizations to increase automation in their processes. SSI has worked closely with health plans for the past decade to efficiently deliver and store this information. Today, we offer seamless attachment throughput and a data warehouse with user-friendly tools for accessing specific claim-related information while complying with data retention rules. As a trusted partner, we provide secure storage and convenient retrieval of this valuable data.

Benefits

  • Enhanced automation: Embrace the power of electronic attachments and authorizations, fueling increased automation in your processes, thereby optimizing productivity and minimizing manual errors
  • User-friendly access: Utilize our user-friendly tools to access specific claim-related information swiftly, streamlining your administrative tasks and aiding in faster decision-making
  • Compliance confidence: SSI is committed to complying with data retention rules and helps you meet regulatory requirements with ease
  • Secure storage and convenient retrieval: With SSI, your data is not only safe but always at your fingertips

As one of the first organizations selected as a Qualified Health Information Network™, KONZA and its technology partner, SSI, are poised to deliver top-tier data exchange services.

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We understand the importance of keeping your member community healthy, and the ability to do so includes quick and easy access to data. With SSI and KONZA, payers can access member clinical data at scale.

Quality Measures Reporting

  • Medical record data retrieval via FHIR will enable payers to quickly gather the data needed to respond to risk adjustment, quality measures such as HEDIS, treatment, payment, and other healthcare operations use cases permitted under HIPAA
  • Clinical documentation retrieval provided in a concise, deduplicated, and consolidated document
  • Our service supports payer risks assessment and adjustment efforts by tapping into our ability to collect and deliver patient clinical data in mass from all needed sources thereby increasing the potential to increase reimbursement
  • Direct messaging using clinical and claims data of key health events that payers may want to receive

More about KONZA
Leveraging its twelve years of Health Information Exchange (HIE) expertise, KONZA partners with and enables innovative HIEs and other integrated networks to further the evolution of healthcare exchange at the national level.

IT Outsourcing

The confluence of workforce shortages and escalating demands is exerting immense strain on IT departments. SSI can bridge this gap by providing a comprehensive range of data hosting options that enable health plans to deliver robust eligibility services in real-time and perform batch scrubbing before claims submission. As the dedicated IT arm of health plans, we bring advanced EDI processing to the industry, ensuring streamlined operations.

Benefits

  • Resource optimization: IT Outsourcing addresses workforce shortages, allowing your team to focus on strategic priorities while we handle the technology complexities
  • Expert support: With SSI as your dedicated IT arm, you gain access to specialists in healthcare IT and EDI processing, thereby ensuring smooth operations
  • Real-time eligibility services: Our data hosting options facilitate robust, real-time eligibility checks, helping to enhance service delivery and patient satisfaction
  • Cost and efficiency: Outsourcing IT to SSI allows you to leverage the efficiency of advanced EDI processing and reduces in-house IT costs

Clearinghouse Services

SSI has established itself as a trusted industry leader with over 35 years of experience as a nationally recognized clearinghouse. Recognizing a need in the marketplace, SSI evolved from exclusively serving providers using our billing solution to now offering an ‘open clearinghouse’ which extends connections to other clearinghouses, vendors, and non-SSI billing customer providers, thereby creating mutual benefits for all involved stakeholders. This allows seamless delivery of claims information, retrieval of ERAs, eligibility confirmation, and real-time status checks on claim disposition.

Benefits

  • Trusted expertise: Rely on SSI’s 35+ years of nationally recognized experience as a clearinghouse, providing you with dependable, high-quality services
  • Expanded connections: Benefit from our ‘open clearinghouse’ approach, extending connections to other clearinghouses, vendors, and non-SSI billing customer providers, fostering an interconnected network
  • Streamlined processes: Enjoy seamless delivery of claims information, retrieval of ERAs, eligibility confirmations, and real-time status checks

Paper Conversion Services

It’s crucial to recognize that paper will continue to be a part of this industry as long as we’re in business. To effectively manage incoming paper and transition to electronic processing, it’s essential to have robust tracking capabilities in place. SSI offers the necessary tools to handle the paper influx and seamlessly convert it into an electronic format, enabling process automation. This transformation results in significant cost and efficiency savings for your organization.

Benefits

  • Seamless transition: Transition effortlessly from paper to electronic processing with SSI’s robust paper conversion services, designed to adapt to industry needs
  • Process automation: Leverage our cutting-edge tools to manage paper influx and automate data conversion, improving operational efficiency
  • Cost savings: Achieve significant savings by reducing manual labor and inefficiencies associated with paper handling

Payer Communication Hub

Establishing effective communication with your provider customers is paramount for a seamless process. However, it’s not enough to announce communications through existing distribution channels. Automating the ERA registration process is also a crucial component. With SSI, you can accomplish this and more, gaining the tools and capabilities necessary to optimize your communication and registration processes.

Benefits

  • Streamlined communication: Facilitate seamless processes by establishing effective, automated communication with your provider customers through a dedicated hub
  • Automated ERA registration: Automate your ERA registration process, boosting efficiency and reducing manual errors
  • Enhanced provider relationships: Strengthen relationships with providers through effective and transparent communication, fostering trust and collaboration

Approximately 25-31% of U.S. healthcare costs, or $950 billion, is spent on healthcare administration. Over 80% is attributed to billing and insurance-related (BIR) expenses.

But did you know…?
A recent McKinsey & Company report showed that the US could cut administrative spending by 30% by automating and streamlining BIR processes.

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