Our Platform Payers

Osigu’s AI cloud-based platform provides payers with automated claims management and clearinghouse solutions that improve accuracy, reduce administrative burdens, ensure regulatory compliance, and optimize payment workflows, all while minimizing fraud and streamlining operations.

Osigu Claims Management and
Clearinghouse for Payers

Osigu’s automated claims management and clearinghouse solutions act as a key intermediary between payers and healthcare providers to ensure accurate and compliant claims processing. It employs real-time validation, automated data scrubbing, and efficient claim routing to streamline operations. With Osigu's solutions, payers reduce administrative burdens and minimize errors and risks, leveraging advanced analytics to enhance transparency and improve overall efficiency.
Key Features

Authorization and Eligibility

Verify eligibility in real-time through advanced API integrations with your policy managers, automatically confirming coverage and enrollment status for the date 
of service.

Prior-Authorization

Streamline your prior authorization process by seamlessly receiving and reviewing providers' requests for medical services. Ensure requests are thoroughly evaluated against policy guidelines and clinical criteria, delivering timely decisions.

Waste, Fraud and Abuse
Scrubbing Rules

Automate claim validations before processing for reimbursement checking patient demographics, provider details, service dates, and codes for contractual compliance. Detect errors, duplicates, unbundled services, and medical necessity issues, with configurable scrubbing rules to reduce waste, fraud and abuse.

Claim Processing

Efficiently manage authorization requests from healthcare providers through our intuitive API. Achieve precise claim processing by accessing detailed transaction information crucial for transparent billing and smooth financial reconciliation.

Claim Adjudication

Validate healthcare claims against policy terms, medical necessity guidelines, and billing codes. Automated adjudication ensures timely approvals, denials, or adjustments, aiding in cost management, fraud prevention, and fair reimbursements.

Medical Coding and Interoperability

Transform your claims process with our CMS platform, which translates proprietary codes into standardized formats (ICD-10, CPT, SNOMED CT). Enjoy accurate data storage, smooth integration with third-party systems, and streamlined authorization and billing. Enhance compliance and data analysis effortlessly.

Pharmacy Benefit Management (PBM)

Manage pharmacy benefits, ensuring rebates and discounts with drug manufacturers are automatically applied to every claim. Save money, enhance transparency, control costs, and improve operational efficiency.

Medical Necessity

Ensure that claims are accurate, relevant, and compliant with current medical standards through our evidence-based guidelines. Verify the necessity of medical services based on diagnoses, reducing ambiguities and enforcing your insurance company’s rules effectively.

Data Analytics

Customize dashboards to keep track of all relevant information captured throughout each step of the claim process, enabling you to make informed decisions with a clear, comprehensive view of every claim.

How it works

Patient Eligibility

Verify patient coverage instantly by connecting directly with payers through our RCM solution. Get real-time validation on the type and status of coverage, ensuring you’re always informed and avoid costly billing errors.

Automated Patient Billing

Ensure precision in your billing process by connecting with payers' core systems. Access real-time information on patient responsibilities, co-payments, co-insurance, and deductibles, guaranteeing your billing is always accurate and on time, accelerating your cash flow.

Revenue Integrity

Ensure precise coding to minimize denials and protect your claims. Keep your revenue intact and avoid costly errors with accurate and compliant billing from the start.

Prior-Authorization

Automate and streamline the approval process for healthcare services before delivery and ensure compliance while efficiently requesting, tracking, and confirming insurance authorizations—all seamlessly integrated with your EHR system, guaranteeing patient coverage.

Contract Manager & Chargemaster

Ensure every billing detail aligns with payer agreements, keeping your prices accurate and your claims clean. Easily manage contracts between payers and providers while safeguarding your revenue—no more leaving money on the table.

Supporting Documents Accuracy

Automate file management ensuring compliance with payer agreements. Attachments can include medical records, imaging results, treatment plans, and other relevant documents to support the billed services.

Claim Electronic Submission

Simplify electronic filing, reduce rejections, and automate tracking. Submit and monitor claims in real-time with automated billing and status updates, ensuring compliance and quicker payments.

Denials, Appeal and A/R Management

Integrate tools for real-time denials management, to efficiently address rejected claims by identifying denial reasons, correcting errors, and resubmitting claims for optimized reimbursement. With automated A/R follow-up, stay on top of unpaid claims, track outstanding balances, and accelerate collections. Say goodbye to delays and revenue loss—get approvals right the first time, every time.

Internal and External Audits

Support regulatory audits with alert notifications and role-based access controls, enabling accurate billing verification. Manage access to data, authorizing external auditors to review patient information only within their designated network, maintaining security and regulatory compliance.

Data Analytics

Make informed decisions, optimize resource allocation, and enhance operational efficiency across your healthcare revenue cycle with a comprehensive data analytics dashboard. Gain deep insights into key metrics to drive better performance and streamline your processes.

Healthcare Payments

Payments

Osigu transforms healthcare payments by seamlessly connecting providers, payers, and patients through automated solutions that ensure fast, secure, and accurate transactions, bridging the gap between healthcare and fintech.

B2B Payments

Osigu's platform integration with our partners' payment infrastructure enables automated and seamless account-to-account transactions between payers and providers, ensuring fast, secure, and accurate real-time fund transfers.

B2C Payments

Osigu simplifies and automates patient reimbursements, ensuring transparency in direct account-to-account transactions by utilizing our partners' payment infrastructure to enhance efficiency and accuracy.

Cross Border Payments

Osigu’s cross-border payment solution simplifies financial reconciliation and payments for overseas claims. By leveraging our partners' global payment infrastructure, we ensure secure and compliant cross-border transactions.

50 W Mashta Dr. Key Biscayne, FL 33149, USA
Developers:
API
Our Platform
For ProvidersFor Payers
About Us
Contact Ushello@osigu.com
© 2024 Osigu. All rights reserved.
Privacy PolicyCookies Settings