Business Process Outsourcing

Catalyst Provides a Full-Service BPO that is Focused on the Needs of Health Plans

Healthcare plans are increasingly utilizing Business Process Outsourcing (BPO) to contract with specialized service providers. Their goal is to drive down administrative costs and activities so they can focus on what they do best: improve healthcare outcomes. Catalyst Solutions offers a comprehensive suite of outsourcing solutions to help healthcare plans meet their goals.

Catalyst believes true success in a BPO relationship can only be built on collaborative partnerships. Our mission is to extend our competencies and scalability to help your plan focus on what really matters – so much so, that we are willing to build financially-based Service Level Agreements into our contracts. This means: we put our skin in the game. We share both risk and reward with you.

Our Areas of Expertise
Claims

Intake, Pricing, Adjudication, Configuration, and More

01

The claims function is central to the health plan business model. Catalyst claims processing team works diligently to ensure our clients’ claims are adjudicated quickly and accurately.

Call Center

Intake, Verification, Call Resolution, Call Triage, and More

02

Catalyst provides a US-based call center that is exclusively focused on the needs of healthcare plans. Our staff is available to your customers around the clock and ready to provide courteous help and expert knowledge.

Enrollment

Products, Billing Entities, and Members

03

The first experience consumers may have with a health insurance plan is in the enrollment process. Plans can take this opportunity to make a positive first impression by ensuring member information is accurately entered into the core system and that the customer is ready to take advantage of their medical benefits on day one.

Billing and Finance

Billing, Collections, Audit, Financial Reporting, and Reconciliation

04

Catalyst is focused on providing high-quality member servicing related to secure, automated billing and revenue collection, Medicare/Medicaid screening, retrospective billing, and reconciliation of reimbursements.

Authorizations

Prior Authorizations, Concurrent, Retrospective, and Necessity Reviews

05

Outsourcing to Catalyst provides the healthcare plan with an effective cost-control process, where Catalyst works with your providers to obtain approval before performing a service to qualify for payment. Our team’s clinicians manage the authorization lifecycle using a combination of technology, data, and clinical expertise.

Medical Management

Case Management, Disease Management, and Population Health

06

Catalyst can help identify at-risk individuals by using clinical staff to holistically manage acute and chronic care needs, support lifestyle wellness initiatives while coordinating with doctors, health systems, and ancillary services. Catalyst’s goals are to help to deliver high-quality health management that is cost-effective and drives successful patient healthcare outcomes.

Appeals & Grievances

Intake, Processing, Tracking, and Resolution

07

Catalyst’s appeals and grievances process is both organized and thorough; designed to ensure quick, fair, unbiased, and appropriate resolutions – with timely communication back to members and providers.

Document Management

Intake, Print, Scan, and Mail

08

Catalyst’s document management services includes all the fulfillment services a plan could need, from post-enrollment collateral to document storage and retrieval, sorting and prepping, and imaging (OCR / ICR).

Problem Solved

Business Process as a Service

In addition to meeting the outsourcing needs of the health plan, Catalyst can provide technology solutions that help health plans meet their unique needs. Catalyst offers technologies for: Claims, CRM, telephony (e.g., ACD, PBX, IVR, CTI and Workforce Manager), authorizations, analytics/reporting, enrollment, pricing, value-based payments.

When introducing new technology, Catalyst can take a modular approach to introducing single aspect of a technology (i.e., a new claims engine). Using this approach, the client gets a new technology that helps improve their business and the effect is both less expensive and less disruptive to the business.

If the client determines their current technology solution no longer meets their demands, Catalyst introduce a comprehensive technology solution and lead the implementation. Given Catalyst’s wide range of partnerships and decades of experience, there’s no technology platform that Catalyst cannot install and manage.

BPO Optimization

Outsourcing business processes drives down administrative costs and allows you to focus on what you do best: enabling better healthcare outcomes.

Get a BPO Audit

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Operations Consulting

Catalyst can customize the right solution for your business to support cost avoidance and ensure compliance in our current ever changing landscape.

Explore Operations Consulting

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Strategic Consulting

Start with a focus on metrics, opportunities for cost reduction, and ways to gain efficiencies in the operations of a health plan.

Explore Strategic Consulting

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Technology Consulting

Using Data to Reduce Cost and Gain Efficiency

In the last decade, the healthcare market has been very dynamic. Not only have there been amazing technological breakthroughs, but there have been numerous mergers and acquisitions. Consequently, technology teams are faced with questions: How do we decrease my total cost of ownership? Why does it take so long to upgrade? What platform should we consolidate to or should we even consolidate? Why does it take so long to make a new product or get into a new market?

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