SLN SOFT SOLUTIONS

Healthcare Payer

Medical Coding Services

Healthcare landscape and regulatory updates that occur almost daily, it is imperative to stay on top of all industry changes in order to maximize revenue and maintain compliance.

Maximizing accuracy at every point in the claims payment process is essential if payers are to compete. Our deep understanding and evaluation methodology of medical claims and contracts enable payers to save money through the identification of overpaid claims.

Member Management

SLN SOFT Solutions manages the eligibility and enrollment process for our clients, including the verification and determination of each member's coverage to help automate the process and free up necessary resources.

Value Added Services

The health plan determines how every insurance claim processes. SLNSOFT Solutions supports plan builds and helps clients determine how everything is defined within the plan to ensure smooth a adjudication process.

Plan building is a critical function of the claims adjudication process. It tells the system how a claim should be processed and what benefits should be applied. SLNSOFT Solutions supports clients in building plans and helps with coding the benefits for all types of services defined in that plan.

Setting up lifetime maximum and annual maximums
Creating benefit codes applicable to the plan
Defining daily/monthly/yearly maximums
Setting up copays for various services
Defining coinsurance, deductibles, and out-of-pocket maximums
Setting up copay, coinsurance, deductibles, and maximums for every service/benefit code
Adding provider networks to the plan
Testing the build
Periodically renewing the service/benefit code in accordance with yearly changes

Value Added Services