Apttus Quote-to-Cash for Healthcare

Effectively Manage Provider Network Agreements, Accelerate Plan-To-Policy and Enable Providers to Deliver More Affordable Care

With Apttus Provider Network and Contract Management, and Quote-to-Premium for Healthcare Payers, healthcare companies can connect their most critical business processes on one data model. Solutions for providers and payers eliminate manual and spreadsheet-based quoting and contracting processes, reduce inefficiencies and revenue leakage, and free up resources so healthcare companies can focus on higher quality, more affordable care.

Apttus Solution

Apttus Provider Network and Contract Management for Payers and Providers

Drive the Optimal Provider Network, From Source-to-Contract

As healthcare reform continues to drive changes in the provider market, providers and payers may spend as much as 40% of their budgets on administrative overhead. In order to manage costs, providers and payers must tighten business processes, with increased visibility and control over provider onboarding and contracting. Apttus connects these critical processes — including onboarding, credentialing, relationship management, contract lifecycle management, rate management and compliance — to simplify the claims process, making it easy to provide accurate information to all relevant parties. With group and individual provider access, and self-service portals to manage address changes, credentials, certifications, and invoices, teams can move with an unprecedented level of speed, and supplier simplicity.

Source

  • Provider engagement
  • Screening and qualification

Onboard

Manage Complex Offerings and Pricing with Ease

  • Provider Onboarding
  • Onboarding workflow automation

Contract

  • Contract Lifecycle Management
  • Intelligent workflows and approvals

Manage

  • Provider performance management
  • Contract Compliance

Renew and Report

Enforce Compliance and Drive Departmental Efficiency

  • Contract renewals
  • Spend assessment

Solutions for the Entire Organization

Performance Manage a High-Quality Provider Network

  • Gain deep insight into provider credentials and contracts
  • 360-degree view of providers, including: credentials, contract details, fee schedules, and group participation
  • Measure providers against contracted quality metrics
  • Initiate reward/remediation workflows

Engage , Empower, and Retain Providers

  • Attract, engage, and onboard with intelligent workflow and approvals
  • Self-service provider portal to manage credentials, access agreements, and more
  • Automate integration to contract terms and fee schedules
  • Initiate contract renewals from current contract information and add/update terms, fee schedules, etc.

Assess Spending and Ensure Compliance

  • Minimize provider network costs and audit/track all aspects of compliance
  • Gain visibility into the latest contract information and fee schedules
  • Track and measure provider compliance against contract parameters
  • Simplify claims and payment validation against fee schedules

Apttus Solution

Drive the Perfect Plan from Quote to Policy to Premium

Healthcare reform continues to drive a number of changes in the payer market, requiring frequent plan updates and increasing the cost to maintain plans. In order to deliver customer-centric and compliant health insurance solutions across the entire customer lifecycle, payer teams must find more efficient methods of doing business. With Apttus, healthcare payers can connect every critical business process — including broker inquiry, assessment, quote proposal generation, premium billing, and policy renewal — on a single cloud platform for better visibility and performance. Rapidly adapt to Affordable Care Act (ACA) requirements, create winning proposals and quotes, transform customer and provider engagement, and optimize core operations — all while ensuring ACA compliance and profitability.

Source

  • Broker Community
  • Product Catalog
  • Workflow rules
  • Census data templates
  • Proposal and Contract Templates

Quote

  • Guided Selling
  • Census Data Management
  • Margin and Profitability Analysis
  • E-Commerce Exchanges
  • Deal Guidance and Approvals

Policy and Premium

  • Contract Authoring
  • Policy Lifecycle Management
  • Agreement Pricing
  • Obligations Management
  • Premium Billing

Renew and Report

  • Plan Updates
  • Policy Renewals
  • Contract and Renewal Reporting
  • Spend Tracking
  • Compliance Reporting

Solutions for the Entire Organization

Know Your Customer Better Than Anyone

Gain insight into all member needs, plan benefits, and member service history across all service areas and channels.

  • Give healthcare payers and partners a 360-degree customer view, including policy info, premium payment history, deductible tracking, claims history, preferred providers, and much more
  • Develop a holistic approach to marketing and selling customer-oriented solutions with on-demand analytics; manage member services and policy renewals, while effectively recommending optimal healthcare providers

Policy-to-Premium Process Automation

  • Gain insight into all member needs, plan benefits, and member service history across all service areas and channels
  • Get a 360-degree customer view, including policy info, premium payment history, deductible tracking, claims history, preferred providers, and more
  • Develop a holistic approach to marketing and selling customer-oriented solutions with advanced analytics
  • Optimize premium billing and accelerate service delivery
  • Generate premium bills for any plan and offer customers multiple payment methods
  • Gain visibility into the latest policy info, premiums, and cost sharing
  • Track customer healthcare spending against policy parameters
  • Proactively initiate renewals from current policies, factoring in existing benefits and rates

Empower Agents, Brokers, and Partners

Allow sales agents, brokers, and channel partners to quickly navigate complicated health
plan configurations, optional benefits, and policy documents

  • Allow sales agents, brokers, and channel partners to quickly navigate complicated health plan configurations, optional benefits, and policy documents
  • Set up state-compliant regional health plan product catalogs and price lists
  • Efficiently manage complex rating configurations and tiers for group, individual, Medicare, and add-on services across all service areas
  • Enable self-service for broker and partner proposals, which seamlessly flow into policies
  • Create plans and optional benefits based on policy history, benefit utilization, trends,
    predictive analytics and drive upsell/cross-sell opportunities