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Payer Administrative Services

Offer fair payment, boost productivity, and increase satisfaction among members.


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Achieve the goals of value-based care and quality outcomes.

In this day and age of minimum medical loss ratios, it might be difficult to preserve a competitive advantage while also optimizing one's bottom-line revenues. Payers are under an increased amount of pressure to generate proper HCC coding as a result of increased oversight from the HHS and the Department of Justice. However, this may prove difficult for organizations that only have a limited number of staff members available to dedicate to these initiatives. RM Healthcare is able to assist you. Our professional staff is able to:

  • Take control of every facet of risk adjustment coding to aid in the improvement of accuracy and the avoidance of penalties.
  • Increase Star Ratings with Streamlined Quality Reporting
  • Conduct preventative chronic care outreach to high-risk patients.
  • Respond to and manage questions from members and medical service providers.
  • Member services including message triage, appointment setting, hospital admittances, and more
  • Lessen the load of managing insurance claims
  • Manage the data and the provider network.

Risk Adjustment Coding Review Services

You can't manage the Medicare Advantage and ACA patients you're responsible for without risk adjustment. We at RM Healthcare are here to assist you. Our HCC coding takes risk factors into account, which leads to more precise records of patient characteristics, illnesses, and overall health. The outcome is more accurate per-person cost estimates and fairer pay for everybody.


RM Healthcare Risk Adjustment Coding Services:

  • 97% - 98% coding accuracy
  • Quickly scale to meet your coding review needs temporary or permanent
  • Up to 60% savings on each medical chart reviewed

RM Healthcare's HEDIS-trained nurses and clinically-trained coders will handle all of your chart abstraction needs across all phases of the process. If you need high-quality source data for HEDIS and Medicare Star reporting, our international team has everything you need: the knowledge, technology, and procedures to get the job done.

In order to analyze encounters and conduct thorough clinical chart reviews, our team of registered nurses will access data from your EMR according to NCQA requirements. Verifying that correct care has been provided, documented, and coded entails reviewing patient diagnoses, treatments, and paperwork.

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RM Healthcare has 110+ HCC coding specialists who code charts for 1.2 million patients and members each year.

Provider & Member Communication Services

For organizations experiencing personnel shortages, responding quickly to member inquiries can be particularly difficult. RM Healthcare's Provider & Member Contact Services can help manage provider and member communication on your behalf, whether it's in response to clinical issues or enquiries about benefits. We work with you to identify the clinical and operational levers with the most potential to affect cost and quality, and then we develop a communication strategy that is tailored to meet your specific needs.


Member Engagement

In addition to our other services, RM Healthcare can assist you in reaching out to your high-risk members in an effort to enhance their chronic care management, save expenses, and boost the quality of life for them. In order to promptly identify concerns requiring proactive intervention, our team of registered nurses and physician assistants analyses data captured from beneficiaries' health monitoring devices.


Provider Outreach

Provider outreach is an integral aspect of our communications services because we recognize its significance. We'll get in touch with your doctors ahead of time to manage administrative activities like physician credentialing and to talk about ways to get more people to use the health benefits provided by the plan. All parties involved (payers, providers, and patients) benefit from this arrangement.


RM Healthcare Provider & Member Communication Services

  • 650K+ patient support calls per month
  • Trained in 60+ EMR/EHR, practice/hospital management systems
  • Close to a Decade experience exclusively supporting the U.S. healthcare system

RM Healthcare handles more than 250,000 patient support calls each month