What types of healthcare companies have you worked with?
Knowledge Rules has worked with for profit and non-profit insurance and healthcare companies that work in both single and multi-state jurisdictions. We find that in every case, quality and timely service delivery is of paramount importance to our customers. Further, we have found that we can scale systems and costs to match customer size and complexity while still delivering sophisticated systems that increase automation, reduce errors and save time.

With which healthcare claims systems do you have experience with?
Our staff has worked on applications that interface with Perot Diamond, EDS TPS, RTMS, Metavance, and multiple in-house systems.

Do you have experience with member services and provider customer service systems?
KR has in-depth experience working with both business and IT to solve complex member and provider service issues to drive increased customer satisfaction (NCQA ratings) though higher first call resolutions and web self service. Our focus is to help organization deliver quality service while managing the cost of delivery.

Where does Knowledge Rules have application expertise in Healthcare?

• Individual and Group Enrollment Portal
• Provider Services Call Center
• Member Services Call Center
• HIPAA Compliance
• Managed Care and Healthcare Maintenance
• Claims Management Pre and Post Adjudication
• CMS / Medicare Medicaid Claims Compliance
• Workflow enabled transaction sets

Where does Knowledge Rules have industry expertise in Healthcare standards and mandates?

• MTM, NCQA and HEDIS standards
• Medicare part B application
• Pega/Claims system integration

What Pegasystems Frameworks have you had experience with in Healthcare?

• HPIF (Healthcare Payer Industry Foundation)
• Claims Repair
• Claims Workstation Plus
• CPM for Healthcare Member Services
• CPM for Healthcare Provider Services
• SPM (Sales Process Manager)