HEALTHCARE SOLUTIONS

JND delivers the most reliable and comprehensive administrative resources and services to our clients in the healthcare insurance space. JND has the experience and expertise to manage every aspect of Business Process Outsourcing (BPO) for healthcare insurance companies of any size and any line of business.

Healthcare Solutions Offerings

Eligibility & Enrollment Processing

Whether it be 834 intake processing, manual adds, updates or terminations, JND’s experienced Healthcare team can manage processing and reporting on a daily, monthly and quarterly basis as well as open enrollment periods.

  • Setting up Employer Groups & Employee Eligibility
  • Setting up Individual Member Records & Eligibility
  • Processing 834 Daily & Monthly files (add, change, term and monthly summary)
  • COB enrollments

Provider Set-Up & Contract Management

Let JND’s experienced teams manage the Provider set-up and their Contract management process for you, so you can focus on building better Provider relationships.

  • Loading & Provider Rosters
  • Setting up Provider records and their affiliations
  • Updates to Provider records

Medical Claim Data Processing

JND provide efficient processing of all paper claims, electronic medical insurance claim forms (via 837), including UB-04, HCFA-1500, and dental claim forms, whilst processing any and all pending claims.

  • Claims Processing (paper, 837 & dental)
  • Pended claims processing and management

Claims Denial & Appeals Management

JND’s claims personnel strategically resolve appeals and distribute acknowledgement and decision letters back to the Providers in a timely manner and recognize appeals regulations. Claims adjustments are processed as necessary based on appeals resolution.

  • Review of denied claims
  • Receipt and review of provider appeals (including acknowledgment & decision letters)
  • Requests and review of medical records
  • Claims adjustments as necessary based on appeal review

Payment Integrity Services

JND’s healthcare team helps clients protect their cost management plan by working to determine if another party is responsible for covered medical treatment, and if confirmed, JND will finalize the health insurance claims recovery process.

Premium Billing & Payment Posting

JND’s financial staff is well versed in premium billing (invoicing) and posting payments for all lines of business – Commercial, Medicare, TPA, etc. Let JND manage this financial process so that you can focus on health care and your members.

  • Run premium billing on a monthly, quarterly, bi-annual and annual basis
  • Receipt and posting of group and individual member payments
  • Delinquency processing (including delinquency letters)

Report Generation

Health care regulations require that all health plans report multiple sectors of data to either a government agency, an external vendor (ie; Rx), Employer groups or internal reporting for operational strategy. JND has the knowledge and capabilities to develop, implement or generate accurate reporting for all your needs.

  • Internal report development for all modules (claims, provider, enrollment, UM, etc.)
  • External report development for all required reports (ie; government, encounters, Rx, etc.)
  • Executive reporting (claims & enrollment metrics, etc.)

Clearing House Activities

Acting as a third-party service provider, JND has the capability to process 835 payment files, enrollment fulfillment (ID cards) as well as printing and mailing.

  • 835 file output and check printing (provider payments)
  • Enrollment ID cards and fulfillment

Data Maintenance & Cleansing

It is very common that Health Plans struggle with erroneous, unorganized provider and member data that requires an initial cleanup project. JND regularly provides this service to our clients so they can feel confident in trusting their data, including encounter data.

  • Claims, Provider, Member & UM data cleanup – analysis and solutions

Claims Software Configuration Support

Is your system generating a large volume of claim edits? Are claims not pricing or paying correctly as expected? JND can provide consulting services and assess the issues, to determine a resolution and perform configuration, as well as any training needs.

  • Claims software configuration assessment & review
  • Proposed solutions and recommendations
  • Configuration training (classroom or ‘train the trainer’)

Operational & System Stabilization

JND’s Healthcare Solutions personnel can assist your organization in achieving operational stability by assessing the daily processes, training needs and systems analysis.

  • Assessment of operational processes and departmental workflows
  • Review of desktop procedures
  • Systems assessment for compatibility
  • Proposed solutions and recommendations

CLASS ACTION ADMINISTRATION

Mass Tort

eDISCOVERY

GOVERNMENT SERVICES

Request a Proposal

If you are interested in any of our services, you can request a proposal by filling out the fields in this section.