Customer relationship management solutions specifically tailored to meet
the needs of health care providers. PegaCARE and PegaCARE-Blue are
designed to help health care organizations: Improve the efficiency and
accuracy of claims processing; Reduce response times in handling telephone
inquiries by members and service providers; Deliver patient, member, payer,
and provider information all to a single screen for call center operations;
Reduce the training and associated costs for service reps; and Improve
their quality of patient care by providing a platform for customer
interaction that supports the entire health care cycle of pre-encounter,
decision-making, episodic care, and clinical outcome with knowledge-based,
best practices scenarios.
These suites of customer relationship management
applications are for HMOs, PPOs, other managed care organizations, and
health insurers. These applications automate workflow processes in many
areas including benefits, payments, claims validation, and customer
inquiries and integrate them into the companies' call centers, where
customer service representatives manage patient care and field member and
provider inquiries.