SHAI FOR PAYERS

Empowering Payers to

Minimize Revenue LeakageReduce Healthcare Admin CostImprove Member and Provider Experience

SHAI helps payers streamline enrollment, optimize payment accuracy across the claims lifecycle, strengthen member relationships, and lower healthcare cost.

Lower Claims Management Cost.
Drive Operational Efficiency With SHAI

Streamline Claims Processing

Accelerate the claims lifecycle, drive accuracy, and reduce errors.

Coding Expertise to Spot Errors Pre-Submission

Post-Payment Claims Audit

Claim Adjudication

Claims Adjustments

Appeals and Grievances Processing

Multi-Domain Claims Processing (Pharmacy, Dental, Vision, etc)

Accelerate the claims lifecycle, drive accuracy, and reduce errors.

Accelerate Benefits
and Enrollment Processing

Enhance member experience and efficiency through tailored processing and maintenance across the member-payer relationship.

Benefits Configuration and Testing

Medicare, Medicaid, ACA, and payment reconciliation

Member Enrollment & Reconciliation

Premium Billing and Invoicing Services

Enhance member experience and efficiency through tailored processing and maintenance across the member-payer relationship.

Manage Provider Data End-to-End

Maintain, update, and analyze provider network data to reduce admin work in loading data, improve network data accuracy, and adhere to compliance regulations.

Provider Intake

Credentialing

Provider Data Aggregation and Validation

Compliance Insights

Contract Configuration and Modeling

Testing

Maintain, update, and analyze provider network data to reduce admin work in loading data, improve network data accuracy, and adhere to compliance regulations.

Mitigate Risk With Quality Assurance

Run risk adjustment programs spanning multiple plans, states, and technological changes, improve risk scores, and meet compliance regulations with 360* data collection.

Chase List and Retrieval

Risk Score Chart Review

HEDIS Chart Follow-ups And Review

Documentation and Data Collection For Compliance

Run risk adjustment programs spanning multiple plans, states, and technological changes, improve risk scores, and meet compliance regulations with 360* data collection.

Manage Benefits Utilization

Review cases. Assess medical appropriateness with data-driven techniques. Lower healthcare cost.

Prior Auth Intake

Case Management

Prospective, Concurrent, and Retrospective Planning and Review

Disease Management

Review cases. Assess medical appropriateness with data-driven techniques. Lower healthcare cost.

How SHAI Handles Transitions and Quality Assurance

Refresher Sessions and 1:1 Training

Weekly EBTs (Error-Based Trainings) and PKTs (Process Knowledge Tests)

RCA, 5 Whys, Fishbone Analysis, Pareto Chart, and CAPA (Corrective Action Preventive Action)

Proactive Daily Team Huddles With Peer Audits

Periodic Calibrations For Continuous Improvement

The Numbers Speak For Themselves

98%+

Transaction Accuracy

40-60%

Payroll Cost Reduction

98%

Financial Accuracy

<5%

AR Time Reduction

20%+

Increase in Collections

99%+

Vendor SLA Compliance

<2%

Denial Rate

90%+

Increase in First Pass Rate

95%+

Claims Adjudicated Within 30 days

Secure. Compliant.
A Payer Services Provider You Can Trust.

ISO 27001

HIPAA
compliant

PHI Policy Rigor With ,[object Object], Clean Desk Policy

PHI Policy Rigor With
Clean Desk Policy

Purpose-Built SSO ,[object Object], Login and Cloud Infra

Purpose-Built SSO
Login and Cloud Infra

The SHAI Promise

Not just a Payer Services provider, but a reliable business partner who works continuously to drive growth & operational efficiency through talent & tech-solutions

STEP 01