Provider services
Make every provider call end in resolution
Provider support, claims, authorizations and education that cut repeat contacts and protect network relationships.
Create a distinctive provider and member experience
With tightening margins and changing consumer expectations, modern health plans have the unique opportunity and incentive to reimagine the future of care delivery.
Our rich consumer engagement expertise and strong analytics capabilities enable in-depth visibility into individual care needs and utilization patterns across provider settings. This, in turn, allows us to proactively identify friction points early in the journey – mitigating downstream impact and making it easy for providers to work with you.
At the same time, our outcome-driven utilization management services integrate better with providers, accelerating pre-authorization, prioritizing necessary services, and improving access to care.
Provider services across the full provider journey
From onboarding a new provider to resolving a disputed claim, ResultsCX helps health plans answer provider questions the first time.
Onboard and educate
Help providers work with your plan from day one.
Provider education on self-service and best practices
Directory management
Self-service adoption to reduce avoidable calls
Authorize
Keep referrals and authorizations moving.
Referral and authorization management
Prior authorization requirements and status
Care coordination insights from authorization data
Inquire
Give provider offices answers, not transfers.
Eligibility and benefits verification
Claim and appeal status
Multichannel support across phone, fax and provider portals
Resolve
Close the issue on the first contact.
Real-time claims adjudication where appropriate
Balance bill resolution
Grievances and appeals handled by trained advocates
#ResultsMatter
Efficiency
Accuracy
Costs
See how accountable AI operates inside regulated healthcare environments.
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How we do it
What sets us apart
Over 30 years of CX experience across multiple industries
KPI-driven delivery for consistent and measurable quality and exceptional CX
Flexible and scalable engagement model to identify issues, analyze CX challenges, and collaborate together
End-to-end expertise across hiring, training, operational execution, and workforce management
