Operations

Call Center

Call Center OpearationsAnother area with deep hidden costs is your Call Center operations. The nature of DME and O&P tends to increase the amount of "human touches" that a plan for a benefit that only represents one to two percent of your total revenue spend, once again driving the cost of the administration through the roof.

Our state-of-the-art call center operations, coupled with our call center staff's intimate understanding of the DME benefit, claims operations and provider network all work together to allow us to gain efficiencies in the administration of your DME and O&P benefits that would otherwise be impossible.

Add to that our focus on customer service and cultural competency (all of our call center staff must be bi-lingual) and you get a level of service that will continue to pay dividends long into the future.

Claims Adjudication

Claims AdjudicationBecause of the complexity of DME and O&P benefit administration, there are many hidden dollars buried in the claims adjudication process. Benefits that don't fit into the norms of claim processing have a tendency to fall out of the usual processes and require human intervention. Examples are: durable rental payments that represent a percentage of the sales cost with specific cut-off dates that vary from product to product, consumable goods with varying monthly maximums dependent on which line of business the member belongs in the list goes on and on.

Because ReliaCare focuses only on the management of your DME and O&P benefit we are able to customize our claims payment software to adjudicate the claims exactly as your benefit designers intended - at a great cost savings to you.



  • Credentialing & Contracting
  • Price Setting
  • Benchmarking & Reporting
  • Access Guarantees
  • Follow payer and regulatory guidelines
  • Follow benefit design
  • Physician Outreach
  • Patient/Family Coordination
  • Delivery Confirmation
  • Regulatory guidelines followed
  • Electronic submission increased
  • Reporting to support benchmarking
  • All languages supported
  • Multi-tiered Operational Reporting
  • Extensive Data Aggregation