Business Process Outsourcing

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.

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.

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.

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.

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.

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.

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.

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).