Our team of healthcare professionals and administrators, located worldwide, offers a comprehensive range of outsourced clinical and non-clinical administrative services to our clients.
From routine to emergent care, each service is customized to enhance both qualitative and quantitative health outcomes. We are committed to delivering exceptional service to our clients through our expert team of professionals.
Customer Services
DMH understands that the health benefits industry requires a multi-pronged approach to providing excellence in care. DMH helps our customers achieve this level of performance and health outcomes excellence with:
Decreased expenses through operations optimization
Scalable ongoing support for the ever-changing health benefits space
Post-campaign queries based on evidence-based evaluation methods to drive future
successes
In addition to these KPI-driven services, DMH also provides softer services which include Provider Relations representatives who provide concierge-level support on matters of day-to-day business management.
Medical Records Processing and Management
DMH helps our customers achieve this level of performance and health outcomes excellence with:
Decreased expenses through operations optimization
Scalable ongoing support for the ever-changing health benefits space
Post-campaign queries based on evidence-based evaluation methods to drive future successes
In addition to these KPI-driven services, DMH also provides softer services which include Provider Relations representatives who provide concierge-level support on matters of day-to-day business management.
Claims Processing
DMH understands that processing claims accurately and timely is essential to provider satisfaction. DMH exceeds regulatory requirements for both quality and timeliness.
DMH claims processing features include:
Claims adjudication for all lines of business: Medicare, Medic-Aid, and Commercial
Provider Dispute Resolutions and Appeals
Encounter Data Processing
Claims Quality Assurance
Paper claims scanning and conversion to EDI
Member Data Management
DMH understands that processing member data must be timely to ensure information is readily available for all member interactions and transactions such as:
Enrollment processing
Eligibility processing
Ongoing data entry
ESRD Transportation and Census Review
DMH understands the high-needs environment of ESRD and that’s why we have agents who specialize in coordinating safe and timely transportation for patients with end-stage renal disease. We carefully vet our transportation vendors to ensure they align with our values of patient-first care, such as door-to-door assistance.
How do we do this at cost-saving to you?
We provide the transportation care team with the following:
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- Positive health outcome care-driven patient information and dialysis schedules to determine the most appropriate facilities for life-saving care
- Necessary medical devices or equipment
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System Configuration
DMH understands that accurate system configuration is the foundation for increased claims automation and payment accuracy. DMH has configuration expertise for all product lines to match your provider agreements for accurate payment and reporting.
How do we do this at a cost-saving to you?
Our systems configuration services include:
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- Provider and Vendor Setup
- DOFR (Division of Financial Responsibility) Setup and Maintenance
- Benefit Setup and Maintenance
- Fee Schedule Maintenance
- Auto-Adjudication Optimization
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Provider Relations
DMH understands that the provider relations team plays a crucial role in building and maintaining strong relationships with healthcare providers, including physicians, hospitals, and medical facilities who participate in our health plans' provider networks.
Our provider relations representatives work directly with providers and their staff to ensure they receive the support they need and to address any questions or concerns they may have.
A few key areas in which our provider relations representatives can assist you include:
Regular communication and engagement
Trainings on regulatory and compliance guidelines
Business development
Credentialing
DMH understands that provider credentialing is a rigorous process that involves verifying and assessing the qualifications of healthcare providers, including doctors, dentists, and other allied professionals.
We adhere to this regulatory-mandated step to ensure health plan members receive high-quality care from qualified, safe, and competent providers.
How do we do this at a cost-saving to you?
We review providers' education, training, licensure, and other qualifications
We provide you with detailed reports on providers’ credentialing status
We alert you when providers’ credentialing is up for renewal