Service Model - Conexia

CLIENT OBJECTIVES

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Provide operational excellence

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Improve quality care for beneficiaries

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Optimize resources to generate savings

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CONEXIA SERVICE MODEL

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INDUSTRY EXPERTISE

With over 20 years of experience and over 250 global employees, Conexia has an unparalleled level of expertise with provider operations, clinical delivery, payer operations and technological solutions for each participant in the healthcare ecosystem.

Conexia has a wide scope of expertise, with clients in public health, commercial health, workers’ compensation and various governmental care programs.

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TECHNOLOGY PLATFORM

Conexia has developed a core technology platform (ONE) that is customizable to meet the diverse regulatory requirements and operational processes for each client in each geography. In most cases, our initial implementation is an overlay on the payer’s existing technology ecosystem to create real-time processes.

The ONE platform includes numerous modules and is designed to be versatile for each client, from micro to macro processes.

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USER SERVICES

Conexia takes a customized approach to supporting the various users with each client. This approach allows us to focus on the preferred methods of contact for each client.

Our partnerships typically include specific service level agreements that allow the client to measure the effectiveness of our response. Conexia trains our staff to provide answers and solutions that focus on the usability of our solutions as well as general technical support.

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MONITORING AND CONTROL

Our analytic tools allow the client to explore real-time data about the population and the performance of Conexia’s solution. The metrics and indicators are customized to the client’s specific needs.

This management dashboard provides real-time decision support to monitor and improve operational performance.

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DEDICATED CLIENT TEAM

Our dedicated client team is there to implement, maintain and continuously adapt the solutions we deliver to clients.

Each client team is comprised of business analysts and technical staff, supported by the broader Conexia team. This structure maximizes impact while leveraging best practices.

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BENEFITS

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Eligibility Verification

Verified by swiping a card or entering information into our portal.

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Care Coordination

All providers have access to the same data for an injured worker.

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Medical Management / Utilization Review

Application of evidence-based medicine at the point of care.

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Statutory & Management Reporting

Customized, real time reports; all data centrally located.

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Claims Processing

Real-time validation replaces claims processes.

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Provider Billing

Real-time authorization automatically generates an electronic invoice.

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Proactive Risk Control Analytics

Track injured worker health in real time & design automated interventions.

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Fraud / Abuse Deterrence

Business rules to detect potentially abusive activity in real time.

Learn more about how Conexia impacts on Workers' Compensation

We make a positive impact on organization's performance. We help drive success for providers, employers, insurers and patients.

More about our Real-time Adjudication

 

At Conexia, we use our deep industry experience to optimize the balance between quality of service for patients, administrative costs and medical costs.
Know more about our Real-time Adjudication for Workers' Compensation

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Put the real-time adjudication solution to work for you

See why Conexia is the leading trusted software vendor in the global payer community.

Case Studies

 

How OEHP improved its rankings in the BWC and surpassed its goals?

OEHP contracted with Conexia to develop and deploy a complete solution for the perform contracted services. The solutions provided by Conexia help achieved OEHP strategic and operational goals, focusing on injured worker experience and improved outcomes at lower cost.
Coming soon

How we decreased in 25% the return to work timeframes?

Learn how Conexia helps generate administrative efficiency and support carrier growth positively impacting the company’s profitability.

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Safe use of drugs, improve cost control.

Conexia’s multidisciplinary team identified patterns in the prescriptions filled at our client’s pharmacies. This change represents a savings of 45% in total costs for medications and improves patient safety.

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A trusted leader in the global payer community