Healthcare SME

Infowave possess extensive and in-depth Subject Matter Expertise (SME) in HealthCare industry that spans across HIPAA and other Regulatory, various Health Plans, different Business Lines, Processes, Health Informatics, Payer Operations, Clinical Analytics, Pharmacy, Population Management and Provider Performance.

Infowave has great understanding enormous amounts of new data available with Payers including HRA, biometrics, risk scores, diseases, conditions, outcomes, ETG, ERG, geographic, social and integrates all these data subject areas to provide a 360 degree longitudinal view of the member across time.

Our comprehensive healthcare domain expertise covers the following areas:

Health Plans: Commercial, Medicare, Medicaid

Business lines: Medical, Pharmacy, Behavioral, Dental, Group Life

Payer operations and Business Processes: Member Eligibility and Enrollment, Providers and Networks, Claims Adjudication and Payment, Premium tracking and Reconciliation, Pharmacy Claims, Lab Results, Disease Management, Case Management, Utilization Management, Healthcare Transaction Portals, Health Risk Assessment (HRA)

Healthcare Informatics: Financial Analytics, Clinical Analytics, Clinical Rules Engines, Predictive Modeling and Risk Scores, Disease Conditions and Outcomes Analysis, Disease Identification and Stratification

HIPAA Standards and Compliance: X12 EDI transactions – 820, 834, 835, 837 I/P/D, 270/271, 5010 Compliance, 4010 to 5010 migration, ICD-10 migration

Regulatory Reporting: Medicare Part C & D Reporting, Medicare RAPS, Medicaid Encounters Reporting