WNS collaborates with payers to drive a host of outcomes, including enhanced patient care, reduced costs, improved Medical Loss Ratio (MLR)-related profitability and optimized provider collaboration, to name a few. We develop evidence-based guidelines across multiple specialties such as radiology, cardiology, oncology, pain, orthopedics and sleep care.

Utilization Management

• Prior authorization
• Concurrent review
• Post-services review
• Appeals and grievances
• MD review / Peer review

Case Management, Disease Management & Wellness Management

• 24X7 nurse helpline
• Health risk assessment
• Patient outreach
• Case management and disease management intake
• Medication adherence

Customer Service

• Member support
• Provider education
• Provider outreach
• Inbound / Outbound enrollment
• Retention and renewals

Quality Improvement

• HEDIS and CMS Star rating
• Quality and compliance support
• Site certification

Value-added Services

• Provider network analytics
• Medical management opportunity analytics and consulting
• Utilization management trendbenders and trendbusters
• Underwriting support

Claims Services

• Intake and data capture
• Adjudication
• Adjustments
• Medical bill review

Injury Management for Auto Medical Liability

• Medical bill setup
• Medical bill review
• Medical management and utilization review
• Contact center

Payer Analytics

• Marketing analytics
• Payment integrity – overpayments and fraud analytics
• Provider data management, network performance analytics
• Clinical data and medical costs analytics
• Data warehouse and business intelligence reporting

We specialize in managing provider functions encompassing administration, revenue cycle and clinical management. Our unique blend of administrative and clinical process management focuses on bending the cost curve, and improving outcomes and profitability.

We bring a skin-in-the-game approach to reimbursement to prevent revenue leakage – through coordination of treatment plans, insurance cover and alternative insurance. We help drive a high clean claims submission ratio underpinned by streamlined billing processes, robust claims follow-up practices and analytics-led decision-making. We ensure there are no payment delays from insurers, reducing the risks of higher Days Sales Outstanding (DSO) and denials. We are compliant with International Classification of Diseases (ICD) and Common Procedural Technology (CDP) coding, and strictly adhere to all accepted medical guidelines.

Office Administration

• Scheduling / On-boarding support
• Patient demographic entry
• Insurance eligibility verification
• Physician credentialing
• Chart retrieval

Utilization Management

• Utilization review support (new admissions and continued stay)
• Pre-authorization support / Follow-ups
• Re-consideration and appeals
• UM billing support

Case Management

• Benefit review
• Care coordination support
• Concurrent review
• Discharge review
• Discharge planning support
• Transition of care support

Medical Billing and Coding

• Billing
• Medical billing charge entry
• Medical / HCC coding
• CPT and ICD-10 coding
• Denial analysis

Revenue Cycle functions

• Medical claims processing
• Accounts receivable services (including follow-up and analysis)
• Payment posting
• Denial management

Value-added Services

• Physician review / Peer-to-Peer services
• Audit / Quality assurance
• Clinical Documentation Improvement (CDI)
• Provider education
• Merit-based Incentive Payment System (MIPS) / Medicare Access and CHIP Reauthorization Act (MACRA)
• Analytics and insights
• Compliance and accreditation support

Provider Analytics

• Denial analytics
• Collection analytics
• Accounts receivable trend analytics

WNS has a long-standing experience in delivering telehealth-related services for both payers and providers. With the accelerated mainstreaming of digital healthcare due to factors such as rising costs and the COVID-19 pandemic, WNS is leveraging next-gen technologies to drive rapid telehealth outcomes for payers, providers and patients. We drive an integrated experience through our end-to-end solutions led by Artificial Intelligence (AI) and cognitive automation / chatbot, Mobile Health (mHealth), analytics and self-service.

Patient Education

• Calls / E-mail / Text
• Social media engagement
• Online health resources
• Live chat, chatbot & self-serve portal
• mHealth

Initial Appointment Setup

• Virtual visit
• New user setup

Case-based Reasoning

• Patient movement and remote admission
• Training
• Store-and-forward
• Case management

Recurring Events

• Alerts and monitoring
• E-record maintenance
• Incident escalation
• Predictive analytics

Care Management

• Nursing triage
• Patient portal support services
• Patient care coordination
• Patient access management
• Disease and wellness management