CORE SERVICES

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Member Services

• Support for inquiries, appeals, complaints, plan changes 
• Education on benefits, wellness programs, and preventive care 
• Drives STAR Ratings: Better CAHPS scores, increased retention, reduced complaints

Enrollment & Eligibility

• End-to-end enrollment lifecycle management 
• Real-time eligibility verification with employer, government, or broker coordination 
• Supports Compliance: Meets CMS timelines and ensures data integrity  

 Ensure seamless, compliant enrollments that keep members covered—and reduce CMS audit risk 

Provider Network Management

•Medical Coding and Billing

•Clinical Contact Center

•Revenue Cycle Management

•Provider engagement

•Recruitment, onboarding, and credentialing of providers

•Eligibility checks, directory updates, and payment issue resolution

•Patient Scheduling

•Transcription and Scribing

 Reduce out-of-network leakage and drive provider satisfaction with proactive, compliant network support 

Telemedicine Support

• Virtual front-desk staffing, appointment scheduling 
• Pre-visit outreach and tech support for members and clinicians 
• Post-visit follow-ups, satisfaction surveys, and billing support 
• Registered Nurses for Wellness Support 
• Improves Access & Reduces Cost of Care: Fewer ER visits, more preventive care   

 Enable scalable, human-centered virtual care with our telemedicine BPO suite—enhancing both access and outcomes 

Utilization Management and Care Management Support

• Membership Services 
• Claims Processing & Adjudication
• Claims intake, validation, coding, fraud prevention 
• RPA-enabled workflows to improve accuracy and reduce turnaround times
• Appeals and Grievances
• Configurations 

 Eliminate rework, reduce error rates, and accelerate cash flow with AI-assisted claims operations 

Technology & Automation Solutions

• AI & Predictive Analytics: Improve service delivery and identify at-risk members 
• RPA: Claims follow-up, provider file maintenance, and prior auth workflows, data entry, forms processing 
• Virtual Agents: 24/7 support for members and staff, improving responsiveness 
• Integration Hub: Syncs with EHRs, CRMs, STARs analytics platforms
• Intelligence: AI models to auto-categorize, prioritize, and assign tickets. 
• Building and integrating platforms and solving function areas challenges  

 Digitally transform your operations with Pulsepointcare's modular tech stack—built for healthcare scale and compliance 

Sales, Marketing & FMO Development

• Licensed agent support for Medicare Advantage and ACA plans 
• Omni-channel sales (voice, web, field agent support) 
• Development of in-house or co-branded Field Marketing Organization (FMO) 
• Drives Membership Growth: Expand market reach and enrollment conversions  

Expand enrollment and improve marketing ROI with Pulsepointcare's licensed agent network and marketing infrastructure