Value Added Services
KKS Tech Solutions utilizes our decades of experience in the payer market to streamline operations and maximize revenue. Our value added services offer additional support to ensure that all aspects of your business operations are functioning smoothly and efficiently.
From plan building to customer call support, and to the analytical insights that help your business function, KKS Tech Solutions will work with your teams to ensure success.
1. Plan Building
The health plan determines how every insurance claim processes. KKS Tech Solutions supports plan builds and helps clients determine how everything is defined within the plan to ensure smooth a adjudication process.
Plan building is a critical function of the claims adjudication process. It tells the system how a claim should be processed and what benefits should be applied. KKS Tech Solutions supports clients in building plans and helps with coding the benefits for all types of services defined in that plan.
Our plan building process includes:
- Setting up lifetime maximum and annual maximums
- Creating benefit codes applicable to the plan
- Defining daily/monthly/yearly maximums
- Setting up copays for various services
- Defining coinsurance, deductibles, and out-of-pocket maximums
- Setting up copay, coinsurance, deductibles, and maximums for every service/benefit code
- Adding provider networks to the plan
- Testing the build
- Periodically renewing the service/benefit code in accordance with yearly changes
2. Customer Service Representative Calling
KKS Tech Solutions assists clients through the benefits, eligibility, claims status, and verification process. Our problem-solving initiatives ensure providers have required information quickly and efficiently.
Customer service representatives play a crucial role in any company. These individuals must be reliable, knowledgeable, and highly organized. At KKS Tech Solutions, our highly dependable, comprehensive CSR service focuses on maximizing ROI for our clients. Our decades of experience in healthcare enables us to provide quality in each and every transaction. We help our clients by answering providers’ calls about benefits, eligibility, claims status, and any other questions. With our strong reputation for problem-solving and adaptability, our call abandon rates are less than 5%.
Eligibility and Benefits Verification:
Through our eligibility and benefits verification, KKS Tech Solutions assists providers by determining whether or not a patient’s policy is active. If the patient’s policy is active, we further assist providers by figuring out which treatments are covered by the patient’s policy. We are also able to give providers a breakdown of the patient’s copay, deductibles, and coinsurance benefits.
We assist providers by providing the status of requested claims and by informing them of how much payment we, as a third-party administrator (TPA), are making to them. If a claim is not processed, we share this information with the provider. We also take requests for adjustments if there are any operational errors reported by a provider.
KKS Tech Solutions’ customer service team helps providers with any appeal requested by verifying the appeal log to check the outcome. Based on the outcome, we provide the appropriate status. If an appeal is still under review, our team requests additional time from providers to complete the review.
Our pre-certification assistance solutions determine whether a procedure requires pre-authorization (PA). If pre-authorization is not obtained, our team is able to assist providers by providing contact details to obtain the authorization before a procedure is conducted.
A major benefit of partnering with KKS Tech Solutions is access to our after-hours voicemail. If a provider reaches contacts us after the workday has ended, he or she has the option to leave a voicemail. Then, our CSR team responds to the provider as soon as possible.
3. Analytical Dashboards
Data and analytics drive informed business decisions. Our custom-designed analytical dashboards provide detailed insights into the crucial numbers that run your business operations.
Real-time data review plays a major role in just about every industry. To quickly gain insight into the most important aspects of the data and competitive analyses, businesses need instant and easy access to data and analytics. KKS Tech Solutions’ custom dashboards allow clients to read and analyze key performance indicatiors in order to obtain better insights on value propositions. With our web and mobile app dashboards, we ensure you never miss any important information on the go or at work.
KKS Tech Solutions’ dashboards provide insight into key analytics with:
- Easy viewing of key performance measures with visual representations
- Straight-forward data display to avoid confusion
- Option to toggle the view of trends by day, week, month, or year
- Customized report generation
- Instant viewing of data via mobile access to examine metrics on the go
- Historical analysis including context, comparisons, and other performance evaluators
- Targeted key access anytime and anywhere