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Insert Client Logo e4e Healthcare Services Comprehensive Solutions for the Healthcare Ecosystem © e4e – Confidential and Proprietary e4e Healthcare Business • Headquartered in Towson, MD, e4e Inc. is a growing, profitable, zero debt and a financially strong company. Our global delivery platform leverages a “right-shore” business model executed from 4 operational centers located in the US, India and Philippines. • With over 19 years of rich experience, e4e carries a strong heritage of providing end to end Healthcare Services – through our Technology Platforms and Software IP. • A cross-border Healthcare Company with proprietary Software Platforms for Revenue Cycle Management, Claims Processing, Audit and Process Automation. IT Enabled Services • Technology agnostic solutions – experience in working with over 30 Provider and multiple Payer Platforms. • Expertise in System and Platform Integration – System Interface, Electronic Data Inter-change and Workflow Efficiency. • We process over 135 million transactions annually and code/ audit over 30 million charts. • HIPAA Compliant systems and processes, e4e is also ISO 9001:2008 Certified & SSAE 16 Type II Compliant Company. © e4e – Confidential and Proprietary & BPO 3 Offices in Countries 2500 + Employees Globally 6000 Physicians & 191 Work with over Hospitals 2 © e4e – Confidential and Proprietary •Customer Support centers •Business Rules Configuration •Fraud , Waste & Audit Solutions •RAC Response Management Solution for Providers •Process Improvement Consulting for Physicians •Ancillary Services for Payers •Business consulting Technology Solutions •Front End Claims Processing and Management •Claims Adjudication and Error Suspense Resolution • HEDIS & HCC Coding Services •Enrollment Membership and Billing Services •Customer Service •Mailroom Service •Grievance, Appeal & Refund Posting •Reports Management Value Added Services •Patient Access Management •Charge Capture including clinical documentation improvement •Claims, Remittance & Denial Management •Hospital, Physician & Remote Coding • DRG Coding •Revenue Recovery & A/R Services •Charge Integrity & Compliance Solutions •Successful EMR driven billing service Payor Services Revenue Cycle Management e4e Service Landscape •Claims Administration Platform •Scheduler •Workflow Solutions including OCR •ICD 10 transition support •Document Management System •Client Service Portal •Member Portal •Managed Services Network & Desktop management 3 Hospital RCM Services Patient Access Management • Scheduling & Registration • Eligibility & Benefit Verification Billing • Data Entry • Cash Posting • Credit Balance Report Medical Coding • Outpatient Visits • Clinic Visits • Emergency Department • Same Day Surgery • Inpatient (DRG) Denial Management • Weekly review to check on denials A/R Follow up • Account Receivables Service • Insurance Follow Up Increased Productivity, Faster Payments, Decreased Costs & Enhanced Patient Service © e4e – Confidential and Proprietary 4 Provider RCM Services • Coding Audit • Charge Master Management • Billing and Coding Research to plug areas of ‘Revenue Leak’ • Account Receivables Service • Calculate projected A/R collections f or outstanding accounts • Monitor, identif y and prevent f uture payment abuses f rom payers • Underpayment Recovery Services Patient Access Management Charge Integrity & Compliance Solutions Charge Capture Revenue Recovery & A/R Services Claims Remittance & Denial Management Remote Coding • Physician and Remote Coding • Coding Staf f Augmentation © e4e – Confidential and Proprietary • Scheduling & Registration • Patient Data Entry • Eligibility & Benef it Verif ication • Point of Service Collection • Charge Capture • Charge Audits f or accurate & compliant billing • Identif y missed charges on retrospective claims • Improvements in Clinical documentation through education session • Seamless integration with Provider Accounting Systems • Electronic Claim Generation and Transmission • Payment Posting • Denial Management • Reconciliation • Ref unds • Provider Data Updates • Patient Billing 5 Payor Services • Member • Provider • Provider/Hospital Directories- Report generation • UM Reports • Statutory Reports • Canned Reports • Receipt and Records of Appeals • Analysis of Appeals • Amount Payable f or f avorable cases • Process f or payment / generate check • Generate provider letter if original denial is upheld • Ref und Posting Data Capture Claim Inf ormation Capture Claim Data Audit Member Validation Benef it Validation Fee Schedule Validation EOB Generation Front End Rules Application and Data Verif ication • HEDIS & HCC Coding Claim Processing & Adjudication Reports Management Member Enrollment • Member Enrollment/ Disenrollment • Provider Management • Benef it Management Grievance Handling & Refund Posting Customer Service Mail Room Services • Scanning and Batching • Optical Character Recognition Conversion © e4e – Confidential and Proprietary • • • • • • • • • Member Inbound Calls • Provider Service • Online Claim Status Query 6 Value Added Services Customer Support Centers • Both Provider & Patient Support Call Centers Business Rules Configuration • Medical Policy Edits • National Correct Coding Initiative • Global Surgery • Procedure-Gender • Add On Codes • Diagnosis-Gender • Diagnosis-Age • Multiple Surgery /Multiple Endoscopy Ancillary Services for Payers • Consulting Services f or Front & Back Of f ice Process Improvements © e4e – Confidential and Proprietary • Plan Benef it Conf iguration • Provider Additions • Provider Contract Uploading • Fee Schedule Maintenance • Rule Upload & Validation Process Improvement Consulting for Physicians RAC Response Management for Providers • Pre-Emptive Audit Solutions • Front End Edits • CMS Audit Support • HEDIS , RAPS Chart Audit • MRA Chart Review, DRG Validation • RAC Response Management including Trackers 7 Delivery Strategy Best of Outsourcing outcomes with “Right-shoring” – a customized model that delivers better efficiency and savings US Onshore - Onsite Rightshoring US Onshore -Remote India Offshore Philippines © e4e – Confidential and Proprietary 8 The Philippines – Why? Single-country risk diversification for e4e To take advantage of the resource pool – attuned to US culture, language etc To leverage the talent availability in the Healthcare domain – 18,000 registered nurses and 200,000 science under-grads The Philippines is known to have better US-English and accent skills, ideally suited for Customer Service/ Support, Self Pay, Collections, AR Follow-up and Coding domains With ICD-10 conversion fast approaching, additionally tap into the Coding talent, particularly for hospital and facility Coding Some of our Clients also wanted parallel service delivery from the Philippines © e4e – Confidential and Proprietary 9 The Philippines – Competitive Advantage Highly Educated Human Capital Services Industry Orientation © e4e – Confidential and Proprietary Strong Govt. Support Robust IT & Infrastructure American Cultural Affinity 10 e4e Location Thomas Renny George Vice President - Sales Mobile: +1 (813) 760 5126 [email protected] Mihir Bhuta Vice President - Sales Mobile : +1 646 431 4540 [email protected] Kathleen Maher Associate Vice President Sales Mobile : +1 617 512 2318 [email protected] Teresa Crawford Associate Vice President Sales Mobile: 214-289-9822 [email protected] © e4e – Confidential and Proprietary 11