(TPAS) SERVICES
(TPAS) SERVICES
DRIVING EFFICIENCY AND COMPLIANCE THROUGH EXPERT TPA SUPPORT SERVICES
Outsourced Operations Support Services for Healthcare Third Party Administrators (TPAs)
Fusion CX offers comprehensive solutions tailored to meet the unique needs of Third-Party Administrators (TPAs). Our services are designed to improve efficiency, reduce costs, and enhance service delivery. We support TPAs with claims processing, enrollment assistance, and member support, ensuring seamless operations while enabling TPAs to focus on their core mission of managing healthcare plans and services.
With over 35 years of experience, Fusion CX leverages advanced technology and a highly skilled workforce to help TPAs optimize their operations, improve member satisfaction, and maintain compliance across all service areas.
TRANSFORMING TPA OPERATIONS THROUGH TAILORED SOLUTIONS
ENROLLMENT & BILLING SUPPORT
Fusion CX helps TPAs streamline enrollment and billing processes with efficient, scalable solutions:
Online Enrollment Assistance
Provide members a seamless online Medicare Open enrollment experience, ensuring accuracy and compliance.
Social Determinants of Health Enrollment Services
Incorporate social factors to better address the needs of diverse member populations.
Billing Services
Ensure timely and accurate billing, improving cash flow and minimizing errors.
Automated Enrollment and Billing Integration
Leverage automation to integrate enrollment and billing systems, reducing manual intervention and enhancing efficiency to improve overall operational accuracy and timeliness.
CLAIMS SUPPORT
We help TPAs manage claims efficiently, ensuring accurate processing and timely reimbursements:
Claim Collection Management
Streamline the collection and management of outstanding claims.
Payment Processing
Facilitate timely and accurate payment processing for all claims.
Claims Adjudication and Settlement
Ensure claims are adjudicated correctly and settled promptly, reducing backlogs.
Claim Submission and Processing
Expedite the claims submission process, ensuring compliance and efficiency.
CUSTOMER & MEMBER SERVICES
Fusion CX’s customer and member support solutions are designed to enhance member satisfaction while ensuring operational excellence:
Member Services & Inquiry Handling
Address member inquiries quickly and professionally, enhancing the member experience.
Care Coordination for TPAs
Help coordinate care between providers and members, improving health outcomes and efficiency.
Customer Service for Member Inquiries
Provide responsive, multilingual support through a 24/7 healthcare call center, ensuring member satisfaction.
Compliance Inquiry Support
Provide regulatory and compliance support to ensure TPAs meet healthcare industry standards.
Payment Posting and Reconciliation
Ensure all payments are posted correctly and reconcile accounts to maintain financial integrity.
Proactive Member Engagement and Outreach
Implement proactive communication strategies to engage members, such as wellness reminders, preventive care alerts, and personalized outreach, ensuring improved member satisfaction.
AI SOLUTIONS FOR TPA OPERATIONS
Arya – Insight Analyst Persona
Provides real-time agent support to optimize claims adjudication and enrollment processes, improving efficiency and reducing errors.
Marketing AI
Empowers sales and marketing teams to drive focused customer acquisition and maximize ROI.
MindSpeech
Delivers voice harmonization and real-time noise cancellation for clearer, more professional customer interactions.
AI QMS
Enhances TPA accuracy with automated audits and compliance checks, ensuring service quality and minimizing errors.
Conversational AI
Cuts call center costs by automating up to 75% of contact center call volumes with trainable voice bots.
THE FUSION CX-FACTOR
20K+
Skilled
Agents
PCI-DSS
Certified
25+
Language
Support
Ensured Business
Continuity
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WHY CHOOSE FUSION CX FOR TPA SERVICES?
Comprehensive TPA Solutions
End-to-end services, including claims processing, enrollment support, and care coordination, tailored for TPAs.
Scalable and Efficient Solutions
Delivers customized workflows and scalable solutions to help TPAs grow efficiently.
Omnichannel, Multi-Lingual Services
Provides scalable, multi-channel, and multi-lingual support to meet diverse TPA needs.
Advanced Technology for Automation
Leverages AI and automation to streamline workflows, reduce costs, and improve accuracy in TPA operations.
FAQS
FAQS
What services does Fusion CX provide for Third-Party Administrators (TPAs)?
Fusion CX offers claims processing, enrollment and billing support, member services, care coordination, and compliance support for TPAs.
How does Fusion CX handle claims processing for TPAs?
We provide comprehensive claims management, from submission and adjudication to payment processing and collection management.
Can Fusion CX assist with TPA enrollment services?
Yes, Fusion CX offers online enrollment assistance and billing services to streamline the enrollment process for TPAs and improve member satisfaction.
How does Fusion CX help with provider and member support?
Fusion CX provides 24/7 customer service for members, handling inquiries, claims issues, and coordinating care between providers and members.
Why should TPAs choose Fusion CX for their operations?
Fusion CX combines decades of experience, advanced technology, and a commitment to customer service to help TPAs improve operational efficiency, reduce costs, and enhance member and provider satisfaction.
