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Overview

Recent health crisis, work-from-home and increase in telehealth, continually changing reforms, emphasis on value-based-care is all driving customer centric approach to healthcare. Most payers are still using legacy systems with severe limitations and low scalability, impairing their ability to cater to modern day demands. Changing regulatory mandates and lack of unified view of member data are slowing down the pace of progress.

Infosys Revenue Management Platform (iRMP) is a hybrid cloud solution powered by Oracle SaaS (Insurance Billing, Analytics and Financials Products) and Oracle PaaS (Platform as Service) product to integrate with on-premise and external systems. iRMP is enables agility in healthcare value delivery for payer organizations. The platform modernize the IT landscape with configurable and scalable solutions to provide customer benefits, operational efficiencies, and improved revenue. iRMP approach enables organizations to reduce TCO , accelerate digital adoption , and integrate with upstream and downstream applications.

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An enterprise solution that helps health care payers improve member satisfaction and reduce administration costs.

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Infosys Revenue Management Platform enables organizations to keep pace with the growing demands of the industry while driving growth and enhancing customer satisfaction.

The solution provides the following benefits:

  • Configurable rule based Premium calculation and template based flexible billing solution provides accurate and consolidated billing reducing the overall customer queries and improves Customer retention.
  • Effective revenue management by automated AR/AP netting of paying patient claims and collecting payments from patients while improving revenue collection.
  • Core Product can support multiple lines of business, small to large member groups, multi-hierarchy enrollment models, and huge volumes of claim processing and settlement.
  • Enables Faster time to market with new product launch, policy management, and premium changes
  • Improved workflow based approvals and automated To-Do notifications improve the efficiency and reduce manual errors.

Infosys Revenue Management Platform provides added benefits with:

  • Template based pre-built Cloud configurations for faster customer onboarding, price calculation and bill templates.
  • Integration framework for seamlessly connecting to upstream and downstream systems.
  • Analytics platform leveraging multiple systems to have visibility to population healthcare goals
  • Automated Regression test suite for Agile Implementation.
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Challenges & Solutions

The platform provides the facility to enable multiple lines of business such as self-funded and ASO, fully insured – groups and individuals, and various plans such as commercial and Medicare-affiliated benefit products in a single product. Data and business processes are segregated from each other, thereby reducing the overall operational and business costs.

It enables revenue optimization through receivable consolidation across lines of business. Built on the latest technology, the platform provides the required security and data privacy that each line of business and jurisdiction demands.

The HIPAA-compliant robust platform secures sensitive data ensuring the confidence of healthcare payers as well as aligning with government regulations.

Payers find it difficult to meet the timelines for new product and policy launches, changes in the policy, or pricing rules mandated by legislative laws, and customer demands.

This has a huge impact when payer institutions want to expand to new jurisdictions, where policy and pricing rules need to be changed as per the state laws. Payers have to quickly pivot and start offering plans to cover the new scenarios.

The platform is based on configuration rules and policies that can be modified, copied, and changed based on need. All changes are audited, and there are checks in place in terms of configurable workflows and version control maintained for future reference and audits. This allows flexibility and helps the solution adapt quickly and easily to new markets.

The platform is prebuilt with a standard set of interfaces for various processes such as enrollment, claims processing, payments, and settlement. Multiple data interfacing models such as file-based models, databases, and web services are supported.

With Infosys Revenue Management Platform, organizations can define and simplify price points with loosely coupled price management processes, controlled price variation capabilities, and highly configurable parameters driven by rules and metadata.

Pricing resolution can be varied based on parameters such as policy and member relationships, geographic rating area, age, segment, and subscription tiers.

Standardized and pre-built processes help to handle premium charges, claim charges, specific stop-loss credits, aggregate stop-loss credits, claim-based fees, enrollment-based fees, ancillary charges, discounts, and level funding.

The facility for different charging and settlement frequencies as per customer needs are provided. With the availability of detailed claim information, pricing model, and policy used, and the option to drill down to the source level information, settlement and reconciliation becomes a hassle-free process. Billing-related IT costs are substantially reduced by streamlining all business processes.