Payer Services
Back-office support for health plans, TPAs and MCOs
Scalable claims, enrollment and remittance operations for health plans, third-party administrators and managed care organizations.
How MedValue helps
Payer back offices spike and dip with enrollment periods and claim volumes. We provide trained, scalable capacity that plugs into your existing platforms.
- Paper claim intake and conversion to ANSI 837 EDI formats
- EOB-to-835 remittance processing and payment data entry
- Member and provider enrollment processing, including open-enrollment surges
- Medical authorization intake and support workflows
- Document capture, indexing and retention with searchable archives
- Fraud, waste and abuse review support, pre- and post-payment
The challenges we hear
These are the bottlenecks that quietly cost revenue. Our team removes them with a documented workflow, clear ownership and weekly reporting.
- Paper claim backlogs delay provider payments
- Open-enrollment volume overwhelms internal staff
- Remittance and EOB keying consumes hundreds of staff hours
- Authorization queues create provider abrasion
- Document retrieval is slow during audits
Capacity that scales with your cycle
We staff up for enrollment periods and claim surges and scale back afterwards, so your plan is not hiring and training seasonal staff every year.
Accuracy and security controls
Role-based access, signed BAAs, audit logging and quality sampling protect member data and keep processing accuracy high across every queue.
Related pages
EDI Services
Paper claims to EDI conversion, EOB-to-835 remittances and claims database support.
ExploreHow It Works
Our onboarding, daily workflow and weekly reporting rhythm, step by step.
See the processGet a Quote
Tell us your specialty, size and volumes and we will build a custom estimate.
Request pricingBuilt for health plans, TPAs and MCOs
Get a custom proposal for your plan operations
Tell us your payer type, membership and the work you want to hand off. We come back with a scoped proposal covering turnaround, accuracy standards, staffing and pricing.
- Scope and turnaround commitments for your claim and document volumes
- Dedicated, trained teams that scale through enrollment peaks
- Accuracy, audit and HIPAA-minded controls documented up front
- Transparent pricing tied to the volumes you actually process
Prefer to talk first? Call 630-430-1040
Get a custom proposal
Tell us about your plan and volumes. We'll come back with scope, staffing and pricing built for your operation.