Fusion CX offers specialized healthcare claims support services designed to streamline the claims lifecycle, from healthcare claims adjudication to payment processing. Our solutions ensure accurate, timely and compliant claims management for health plans, TPAs and providers, enhancing operational efficiency while improving the experience for members and providers alike. Our end-to-end assistance improves accuracy, compliance and overall operational efficiency across your claims process.
We combine advanced technology with a skilled, healthcare-trained workforce to handle complex claims processing needs, reducing administrative costs, accelerating reimbursement cycles and keeping every step in line with regulatory requirements.
Claims support rarely stands alone. Our teams connect it with eligibility verification, enrollment and billing and member support, so a claim question on the phone and a claim in the queue are handled by people who see the same record.
Two connected workstreams for TPAs and health plans: getting the decision right, then getting the money out the door.
Claims adjudicated in accordance with health plan guidelines, so settlements are timely, accurate and consistent across every claim type.
Fewer errors and disputes in claims settlements, strengthening relationships between health plans, providers and members at every stage.
Claims resolved quickly with fair settlements for providers and members, and clear communication about every outcome and next step.
Processing that follows regulatory standards and payer guidelines, reducing compliance risk and building trust among plans, providers and members.
Prompt, accurate payments to providers that reduce delays, protect cash flow and improve provider satisfaction with the plan.
Automation that streamlines payment processing, reduces administrative burden and keeps payment cycles moving without manual bottlenecks.
Payment discrepancies identified and addressed promptly, with root causes documented to maintain financial integrity across the claims ledger.
Real-time payment status for providers and members, improving transparency, reducing inbound inquiries and building confidence in the process.
Most claim calls trace back to a claim that stalled somewhere. Here is how we keep them moving from intake to payment.
Claims and supporting documents checked for completeness and member eligibility on arrival, so gaps are caught before they reach adjudication.
Analysts review claims against plan benefits, coding and payer guidelines, with a second look on high-value or complex claims.
Underpayments, overpayments and provider disputes routed to a dedicated queue with documented reasons, owners and clear follow-up timelines for each case.
Providers and members get proactive status updates by phone, email or portal, which reduces repeat calls about the same claim.
Omind products sit inside every claims program. Analysts stay in control of every decision that affects coverage or payment.
Runs real-time audits and compliance checks on claims interactions against HIPAA and CMS requirements, flagging billing issues, errors and potential fraud before they repeat.
GenAI voice agents give members and providers 24/7 claim status and payment updates, with a clean handoff to an analyst.
Real-time accent harmonization and noise suppression, so complex claim, payment and benefit discussions stay clear and professional for every member.
End-to-end claims coverage with the controls and scale a regulated program needs.
Adjudication and payment processing handled together, for timely, accurate and compliant claims management.
Fast, seamless claims resolution that strengthens provider relationships and lifts member satisfaction.
AI-powered tools and intelligent automation speed adjudication and cut manual intervention in payments.
Claims teams that flex with your health plan's volumes and evolving requirements as operations grow.
PHI handling, access controls and audit trails on every workflow, with PCI DSS and ISO/IEC 27001:2022.
Native-language claims support and business continuity across 40+ delivery centers in 13 countries.
What happened when health plans and healthcare companies handed member and operational support to Fusion CX.
Tell us about your claims volumes, adjudication rules and payment workflows. A healthcare CX specialist will follow up with a scope, ramp plan and pricing.
Guides for TPAs and health plans running claims and member support.
The questions TPAs and health plans ask us most often about claims support.
Fusion CX offers claims adjudication, settlement services and payment processing to ensure timely and accurate claims management. We also support discrepancy resolution and real-time payment status updates for providers and members, so health plans and TPAs can cover the full claims lifecycle with one partner.
We use advanced technology and automated tools to review and adjudicate claims in accordance with health plan guidelines. This reduces errors, keeps decisions consistent across claim types and ensures compliance with regulatory standards and payer requirements.
Yes. We identify and address payment discrepancies quickly, ensuring that claims are settled in a timely and accurate manner for both providers and members, and that the root cause is documented to prevent repeat issues.
Fusion CX uses AI-driven automation tools to streamline claims adjudication and payment processing. Automation handles repetitive steps and flags exceptions for analyst review, reducing administrative costs and improving efficiency without removing human judgment from coverage decisions.
Fusion CX combines 22 years of expertise, AI-driven solutions and a commitment to accuracy and compliance to deliver dependable claims support services. Our HIPAA-compliant teams scale with your volumes and connect claims work with member and provider support.
