PROVIDER SERVICES

MEMBER SERVICES

OPTIMIZING PROVIDER ENGAGEMENT FOR BETTER HEALTH OUTCOMES

Comprehensive Support for Healthcare Providers

Fusion CX delivers tailored provider services to streamline operations, enhance care delivery, and improve collaboration between healthcare provider services and health plans. Our solutions include provider customer service, credentialing support, and fraud, waste, and abuse detection, ensuring that providers can focus on delivering quality patient care while we handle the complexities of administration.

With over 35 years of experience, Fusion CX combines advanced technology, scalable solutions, and empathetic support to deliver exceptional healthcare provider services, empowering providers with the tools they need to succeed in an evolving healthcare landscape.

TRANSFORMING MEMBER SERVICES THROUGH TAILORED SOLUTIONS

Provider Customer Service

Deliver responsive, accurate assistance for claims, benefits, and network participation inquiries while ensuring seamless 24/7 communication between providers and health plans through a dedicated healthcare call center.

Provider/Facility Profiling

Maintain comprehensive provider and facility profiles with accurate, up-to-date information across all systems to ensure efficient network management.

Support for Provider Claims and Billing

Address claims-related inquiries, resolve disputes, and assist with billing challenges to ensure accurate and timely reimbursements for providers.

Credentialing and Network Participation

Facilitate provider and facility credentialing to meet compliance standards and streamline network onboarding with guided support for documentation and processes.

Fraud, Waste, and Abuse (FWA) Detection

Leverage advanced analytics and AI tools to proactively identify and mitigate fraudulent activities, safeguarding financial integrity and ensuring regulatory compliance.

Data-Driven Provider Performance Insights

Offer analytics-driven insights into provider performance metrics, helping health plans identify trends, improve care delivery, and optimize network efficiency.

AI SOLUTIONS FOR PROVIDER SERVICES

Arya (Provider Support Coach)

Provides real-time assistance to streamline provider credentialing, eligibility verification, and claims processing, ensuring compliance and faster approvals.

Conversational AI

Enhances communication with AI-driven voice bots for credentialing updates, eligibility verification, and claims status inquiries, improving responsiveness and efficiency.

Marketing AI

Drives provider engagement and retention through targeted outreach campaigns, personalized updates, and streamlined network participation processes.

AI QMS

Automates audits and compliance checks to maintain provider data accuracy, regulatory compliance, and high service quality standards.

MindSpeech

Ensures professionalism and clarity in provider interactions with voice harmonization and real-time noise cancellation, enhancing communication quality.

WHY CHOOSE FUSION CX FOR PROVIDER SERVICES

Streamlined Administrative Processes

Our solutions handle credentialing, claims, and billing, freeing providers to focus on patient care.

Provider Experience

Advanced analytics identify and mitigate fraud, ensuring compliance and protecting provider networks.

Enhanced Provider Experience

Fusion CX’s provider customer service ensures seamless communication and support, fostering stronger provider-health plan relationships.

Scalable and Flexible Solutions

Fusion CX adapts to the needs of providers of all sizes, offering customized support for complex operations.

THE FUSION CX-FACTOR

10.5K+
Skilled
Agents

PCI-DSS
Certified

25+
Language
Support

Ensured Business
Continuity

GET IN TOUCH

 Kindly fill-out the following form and we will get back to you.

    Related Posts

    Post thumb

    Balancing Profitability and Compliance in Consumer Lending Customer Service Operations

    Read more
    Post thumb

    Ecommerce Seller Support Services: Building Stronger Marketplaces Through Better Seller Operations

    Read more
    Post thumb

    The New Control Tower: How Remote Assistance Improves Uptime for AV and Delivery Drones

    Read more
    Post thumb

    Shopify Support Outsourcing Success: How Our BPO Team Elevates Your Retail Customer Experience

    Read more
    Post thumb

    Driving Modern Travel CX Solution with Hospitality Call Center Outsourcing in the USA

    Read more
    Post thumb

    The Hidden Workforce Behind Autonomy: How Tech Ops Teams Enable Safe and Scalable Robot Fleets

    Read more
    Post thumb

    The Onshore Advantage: Why USA-Based BFSI Customer Care Support Is Strategic Gold

    Read more
    Post thumb

    2025 Retail CX Survival Guide: Why Outsourcing Customer Service Matters This Peak Season

    Read more
    Post thumb

    Why Reinventing Commercial Lending CX will Define for B2B Banking Success

    Read more
    Post thumb

    How Commercial Lending BPO Is Transforming Payments and Verification – The Digital Shift

    Read more

    FAQS

    FAQS

    What provider services does Fusion CX offer?

    Fusion CX provides provider customer service, credentialing support, fraud detection, and claims and billing assistance tailored to healthcare providers’ needs.

    How does Fusion CX streamline credentialing for providers?

    We assist with documentation, onboarding, and compliance, ensuring providers can join networks quickly and efficiently.

    Can Fusion CX help with claims and billing challenges?

    Yes, we support providers by resolving billing issues, processing claims inquiries, and facilitating faster reimbursements.

    How does Fusion CX detect and prevent fraud?

    Using advanced analytics and AI, we proactively identify suspicious activities and implement measures to protect providers and health plans.

    Why should providers choose Fusion CX for administrative support?

    Fusion CX combines 35+ years of expertise, cutting-edge technology, and empathetic service to deliver exceptional provider services that streamline operations and improve provider satisfaction.