UNITED STATES OUTSOURCING COMPANY

DESCRIPTION
Tela is a BPO services provider based in the United States & India. We focus on providing BPO services to health payers, health plans, third party administrators (TPAs) and other managed care vendors who are exploring the possibility of outsourcing business processes. Our focus is on the healthcare (payer) industry in the United States.

We have a very strong onshore as well as offshore management team with experience in offshore outsourcing as well as the healthcare industry. Our mission is to work with our clients in providing them with end-to-end and cost effective solutions across the entire healthcare value chain and enable them to draw competitive advantage in the marketplace.

Company Facts:
Backed by Adaptis Inc. (US) & MD India (India)
Focused healthcare BPO services provider
Both onshore & offshore delivery capabilities
Providing end-to-end solution
20000 sq. ft facilities
Current manpower strength at 300+

SKILLS
Medical Policy and Management:

Medical policy development
Health plan specific (include employer)
Medical policy communication and education
Utilization management (e.g., pre-authorizations, case management, etc.)
Claim medical management (e.g., medical necessity, appropriateness of care, coding, etc.)
Disease management and wellness program development and delivery
Case management
Clinical quality

Claims Administration:

Data capture and data entry
Adjudication (except high dollar)
Claims cost management
Medical review
Authorization/referral
Routing claims to correct offices

Enrollment:

Sales & enrollment services
Data capture (including scrubbing, follow up, and data entry, as well as edit, and archiving)
ID card generation and distribution

Customer Service Administration:

Member inquiry resolution (calls and correspondence)
Provider inquiry resolution (calls and correspondence)
Member outreach
New member welcome calls
Telephone satisfaction surveys
Disenrollment surveys
Complaint follow ups
Nurse triage
Grievance and appeals
 
Billing, Collections and Receivables Management:

Invoice production and distribution
Cash receipts and applications
Revenue and member level reconciliation’s
Medicare/Medicaid reconciliation’s
Exposure analysis
Past due receivables collections
 
Group and Plan Setup and Maintenance:

Group information installation and maintenance
Plan of benefits installation and maintenance
Member material production and distribution (SPD’s and collaterals)
Stop loss contract issuance

Accounting and Financial Reporting:

Revenue reporting and analysis
Medical cost reporting and analysis
Claim expense bank accounts management
Stop loss reporting
GAAP, stat and management reporting and analysis
Capitation reconciliation and payment (pool ledger accounting)
 
Specialty Services:

Dental claims administration
Vision claims administration
COBRA administration
FSA administration
Defined

TERMS
Tela Sourcing LLC, one of the very few vendors having an onshore BPO facility in Seattle, Washington in addition to our offshore center in Pune, India. We are currently working with various insurance companies, health plans and TPAs in the US and provide for savings upto 50% of cost with no real upfront investment and a 99.5%+ accuracy.

LOCATION United States - Baltimore, Maryland EMPLOYEES 100-499 YEARS IN BUSINESS 1-3 years CONTACT INFORMATION Register or Login to view the outsourcing service provider contact information.