A capability overview of Stafing and Enrollment solutions from Dell Healthcare Services. Browse through the deck to discover how Dell Healthcare Services can help your organization become future-ready. Learn more at Dell.com/healthplans

1. Healthcare Staffing
Services
Dell Healthcare Services
Staffing Services Capability Overview

2. Dell - Internal Use - Confidential2
Dell Enrollment and Billing
Overview

3. Dell - Internal Use - Confidential3
Solutions
Rating and quoting
Premium billing
and payment
Enrollment and
eligibility
verification
Key benefits
Life event
management
CSR dashboard
Interfaces and
integration
Compliance and
reporting
Quality assurance
and testing
Why Dell
Enrollment and billing
Dell Enrollment and Billing Solution is a robust enterprise integration solution offered for
private exchanges to enable secure, real-time quality transactions between health plans,
providers and federal/state systems.
We can help you
with:
 Rating and quoting
 Premium billing and payment
 Enrollment and eligibility verification
 Life event management
 CSR dashboard
 Interfaces and integration
 Compliance and Reporting
 Quality assurance
and testing

4. Dell - Internal Use - Confidential4
Solutions
Rating and quoting
Premium billing
and payment
Enrollment and
eligibility
verification
Key benefits
Life event
management
CSR dashboard
Interfaces and
integration
Compliance and
reporting
Quality assurance
and testing
Why Dell
Rating and quoting
Provides robust solution for quoting new prospects and delivering customized proposals.
• Complies with
PPACA*-mandated
rules
• Provides seamless
and accurate rate
processing
• Supports wide range
of benefit options for
health plan and
ancillary products
• Provides detail view
of the premium
calculations
• Callouts third-party
data validation
Key benefits:Calculate premiums based on a robust set of rate attributes
Generate real-time quotes for group and individual members
Take advantage of a flexible, rule-driven rating engine
Determine rates through a flexible rate matrix with multiple family tiering
Design and deploy new plans and bundles easily

5. Dell - Internal Use - Confidential5
Solutions
Rating and quoting
Premium billing
and payment
Enrollment and
eligibility
verification
Key benefits
Life event
management
CSR dashboard
Interfaces and
integration
Compliance and
reporting
Quality assurance
and testing
Why Dell
Premium billing and payment
Provides complete billing, payment collection and premium remittance processing.
With full-featured billing and payment, insurers can rely on accurate revenue recognition and
receivables management.
• Allows flexible billing
cycle schedule
• Displays billing and
payment
activity history
• Provides secure and
quick payment
process
• Allows payment from
multiple sources
• Ensures accurate
payment processing,
including subsidies
Key benefits:Produce all data needed for billing and remittance
Process annual/retroactive enroll and ad-hoc rate changes and updates
Generate individual, group or split bill to facilitate billing premiums and
fees
across multiple entities
Manage complex billing and payment plans
Process electronic/paper form of payment

6. Dell - Internal Use - Confidential6
Solutions
Rating and quoting
Premium billing
and payment
Enrollment and
eligibility
verification
Key benefits
Life event
management
CSR dashboard
Interfaces and
integration
Compliance and
reporting
Quality assurance
and testing
Why Dell
Enrollment and eligibility verification
Provides a modern approach to processing enrollments from state, federal and private
exchanges. These services ease the administrative burden of benefits management and
reporting while increasing enrollment and participant satisfaction.
• Reconciles plan
benefits and rates
• Easily manages and
reports on
enrollment,
participation and
accounts
• Customizes data
quality and business
validation rules
• Provides robust
eligibility verification
• Allows easy and fast
enrollment and
renewal
Key benefits:Simplify group contract and enrollment processing
Support HIPAA 834, 270 and 271 transactions
Synchronize data with internal and ancillary systems
Comply with PPACA enrollment policies and procedures
Reconcile member information with internal and external systems

7. Dell - Internal Use - Confidential7
Solutions
Rating and quoting
Premium billing
and payment
Enrollment and
eligibility
verification
Key benefits
Life event
management
CSR dashboard
Interfaces and
integration
Compliance and
reporting
Quality assurance
and testing
Why Dell
Life event management
Provides complete member and rate change event notification.
• Allows flexible
member change
event configuration
• Supports 100+
member
life event changes
Key benefits:Process life change events under three categories: members, job and
retirement
Support proactive and retroactive membership changes due to open
enrollment
Configure event for specific set of member and group
Process ad-hoc and annual premium rate changes
Track member reinstatement and demographic changes

8. Dell - Internal Use - Confidential8
Solutions
Rating and quoting
Premium billing
and payment
Enrollment and
eligibility
verification
Key benefits
Life event
management
CSR dashboard
Interfaces and
integration
Compliance and
reporting
Quality assurance
and testing
Why Dell
Customer service representative dashboard
Provides comprehensive information about subscriber and their eligibility, billing invoices,
payment history and accepts electronic payments (EFT).
• Manages call
center productivity
• Accepts EFT one-time
premium payment
• Tracks subscriber
outstanding
premium, payments
and adjustments
• Maintains and
manages group and
member data
Key benefits:Manage customer contacts and issue resolution
Manage member EFT configuration and schedule
Gain single view of member/employee information
Manage appeals and grievances according to policies
Review billing and payment history

9. Dell - Internal Use - Confidential9
Solutions
Rating and quoting
Premium billing
and payment
Enrollment and
eligibility
verification
Key benefits
Life event
management
CSR dashboard
Interfaces and
integration
Compliance and
reporting
Quality assurance
and testing
Why Dell
Interfaces and integration
No health information exchange is an island. Provides efficient health plan system
functionality with seamless integration across federal systems and state agencies
and other vendors as appropriate.
• Integrates with claim
system for paid thru
date processing
• Applies data integrity
and business rules
up front
• Supports standard
and custom
integration formats
• Provides outbound
and inbound
transaction
automation
Key benefits:Effectively manage and analyze member interactions
and data throughout the life cycle
Integrate with ancillary account receivable and general ledger systems
Execute real-time data integration – scalable to meet high volume
Interconnect seamlessly across multiple exchanges
Take advantage of industry standard integrations

10. Dell - Internal Use - Confidential10
Solutions
Rating and quoting
Premium billing
and payment
Enrollment and
eligibility
verification
Key benefits
Life event
management
CSR dashboard
Interfaces and
integration
Compliance and
reporting
Quality assurance
and testing
Why Dell
Compliance and reporting
Supports accurate tracking and reconciliation of payments. A series of standard reports meet
most of the required reports used by health plans
• Provides more than
15 standard reports
• Integrates with third-
party product by
leveraging data and
analytics
Key benefits:Generate compliance and regulatory reports
Track metrics through dashboard
Generate enrollment, participation and account report
Provide accurate coverage information to bill accurately for services
Ensure accuracy by integrating a variety of transactional and functional
data from key business systems

11. Dell - Internal Use - Confidential11
Solutions
Rating and quoting
Premium billing
and payment
Enrollment and
eligibility
verification
Key benefits
Life event
management
CSR dashboard
Interfaces and
integration
Compliance and
reporting
Quality assurance
and testing
Why Dell
Quality assurance and testing
Provides multiple test disciplines and practices to integrate customer-specific
test requirements into the overall test strategy.
• Ensures quick,
quality
implementation with
more than 40,000
ready-to-use test
cases
• Tests quality
assurance framework
for healthcare payer
solution
Key benefits:Provide a full range of testing services
Enable strategic test consulting
Execute proven test processes, strategies and governance models
Provide specialized testing services in emerging areas such as mobile,
analytical, security, and agile
Deploy ready-to-use innovative test solutions and frameworks

12. Dell - Internal Use - Confidential12
Solutions
Rating and quoting
Premium billing
and payment
Enrollment and
eligibility
verification
Key benefits
Life event
management
CSR dashboard
Interfaces and
integration
Compliance and
reporting
Quality assurance
and testing
Why Dell
Why Dell
Managed individual
enrollment and
billing for more
than 14 health
plans for a state-
based HIX
Managed
enrollment and
billing for
Medicare,
Medicare Part-D,
CHP and HIX
LOBs
Processed more than
55 percent of all HIX
memberships and
benefits for 600,000
members in a large
California health plan
Integrated with
the data
service hub’s
direct
enrollment
Managed more than
1.3 million
enrollments per
annum, with 98
percent
of changes processed
within 48 hours

13. Dell - Internal Use - Confidential13
Solutions
Rating and quoting
Premium billing
and payment
Enrollment and
eligibility
verification
Key benefits
Life event
management
CSR dashboard
Interfaces and
integration
Compliance and
reporting
Quality assurance
and testing
Why Dell
E&B key benefits
Speed Efficiency Bottom line
Easily introduce new consumer-driven
retail products/plans
Quickly enroll new groups and
members
Turn around premiums faster
Streamline invoice processing and
receipts
Ensure accurate payments and
adjustments
Lower administrative costs/ Increase
cash flow
Manage an unlimited number of
complex contractual and payment
relationships
A nimble architecture that can easily
accommodate changes as the
healthcare reform evolves
SOA-enabled framework for simple,
scalable, and secure interoperability
Comprehensive or modular
components to manage all
administrative functions

14. Dell - Internal Use - Confidential14
Dell Fraud, Waste and
Abuse Solutions Overview

15. Dell - Internal Use - Confidential15
Solutions
Fraud, waste
and abuse
Coordination
of benefits
Subrogation
Consulting
and integration
Third-party
recovery
Utilization
management
Fraud, waste and abuse
Dell Fraud, Waste and Abuse Solutions enable you to capture more revenue and automate
payment authorizations with proven toolsets for screening, scoring and coordinating benefits
so you can improve payment integrity and boost revenue recoveries.
We can help you
with:
 Improve pre-pay screening for direct savings
 Use advanced analytics to improve audit and recovery results
 Increase referrals using provider risk scorecards
 Reach new markets with predictive modeling and case management
 Implement best practices across Medicare, Medicaid, and commercial
clients
 Utilize Dell’s pool of experienced registered nurses, coders, clinicians,
pharmacists, statisticians and data analysts
 Educate providers on best practices for claims coding and submission

16. Dell - Internal Use - Confidential16
Solutions
Fraud, waste
and abuse
Coordination
of benefits
Subrogation
Consulting
and integration
Third-party
recovery
Utilization
management
Fraud, waste and abuse
Rapidly identify aberrant providers, track member behavior, and use powerful analytics to
interrogate pre-payment claims—from prepay through recoveries—and all from a single
source. Backed with a team of certified coders and medical professionals.
• Advanced integration best practices
and strategic partnerships
• Comprehensive FWA detection,
management to improve efficiencies
• Automated Claims Evaluator (ACE,
by HMS) to provide complimentary
claims analysis
• Expert clinicians and advanced ICD-
10 tools to investigate and perform
medical necessity and utilization
reviews
• Analysis of suspicious incidents
across disparate processes and
systems
Key benefits:Prepay clinical reviews before payment
Forensic coding and predictive analytics customized to
federal/state regulations and plan-specific policies
Incident analytics and reviews of more esoteric
services
Investigative support to ensure quality of findings and
recoveries
Single source under one roof allows cohesion of
communications and results

17. Dell - Internal Use - Confidential17
Solutions
Fraud, waste
and abuse
Coordination
of benefits
Subrogation
Consulting
and integration
Third-party
recovery
Utilization
management
Coordination of benefits
Automate coordination of benefits with other carriers to verify eligibility, coverage and
coding, as well as identify overpayment, recoveries or claims paid inappropriately.
• Pioneered solution for Medicaid in
1985
• Applied knowledge to Medicaid MCOs
in 2005; now working with nearly
250 Medicaid MCOs
• Can recover 2% of total spend and
generate a 5:1 ROI on cost
avoidance
Key benefits:A verification approach
Accurate identification between primary and
secondary payers
Expedited recovery
Claims re-verification
An improved payer of last resort status

18. Dell - Internal Use - Confidential18
Solutions
Fraud, waste
and abuse
Coordination
of benefits
Subrogation
Consulting
and integration
Third-party
recovery
Utilization
management
Subrogation
Orchestrate accurate recovery and payments from a variety of information sources
through improved data mining and billing.
• Covers all types of claims, including
casualty and workers compensation
• Rule-based triggers and algorithms,
behavioral analysis, and statistical
data analysis
• Maestro state-of-the-art case
management system
Key benefits:Easy, secure 24x7 Internet access
Real-time updates
Paperless process via imaged documents
Automated prompts that drive workflow
Little or no need for internal IT support

19. Dell - Internal Use - Confidential19
Solutions
Fraud, waste
and abuse
Coordination
of benefits
Subrogation
Consulting
and integration
Third-party
recovery
Utilization
management
Third-party recovery
Identify and coordinate the responsible party for primary payment of claims to prevent
or reduce payment/overpayment of claims, as well as research and capture payments,
settlements, judgments and reimbursements to compensate for losses.
• Clients save more than
$7 billion per year
through our cost
avoidance services
• Largest database of
eligibility information in
the nation; receive
enrollment files from
more than 1,000
insurance plans with
more than 1B
segments of coverage
• Recovery provided to
more than 40 Medicaid
agencies and
numerous commercial
plans
Key benefits:Proprietary data mining techniques applied to identify member
coverage with other payers (Medicare, TRICARE, commercial)
Initiate recovery via direct billing or disallowance
Case management of all coverage information to avoid paying claims
when another party is liable

20. Dell - Internal Use - Confidential20
Solutions
Fraud, waste
and abuse
Coordination
of benefits
Subrogation
Consulting
and integration
Third-party
recovery
Utilization
management
Utilization management
Control the authorization and best use of benefits through licensed care managers, nurses,
physicians and other key clinicians. Evidence-based clinical guidelines drive high-quality care
through tools such as care pathway tables, flagged quality measures and integrated medical
evidence.
• Uses care guidelines
from MCG Health
(former Milliman
Care Guidelines) for
length of stay,
days/1000,
admits/1000, which
defines evidence-
based best practices
• Oversees
prospective,
concurrent, and
retrospective
reviews
• Provides DRG
validation, quality of
care, bill audits
• URAC-accredited
registered doctors
and nurses
Key benefits:Standard week-day call center along with urgent call center available
24/7 for weekend emergency pre-certifications and appeals
Experienced case/care management nurses with active licensure in the
state of practice, diverse medical backgrounds and at least five-years
clinical experience
Intake coordinators with four-year degrees, prior call center
experience, and/or medical coding/terminology knowledge
Automated triggers in the system to identify members who may benefit
from case management intervention
Offer flexibility to customize group-specific business rules

21. Dell - Internal Use - Confidential21
Solutions
Fraud, waste
and abuse
Coordination
of benefits
Subrogation
Consulting
and integration
Third-party
recovery
Utilization
management
Consulting and integration
Provide ongoing support and subject matter expertise to analyze existing or needed systems
for
client-specific industry-leading solutions.
• Clear understanding
of system portfolio
creating deep insight
into the present state
• Roadmap and plans
based on the present
state account for
actual processes and
assets in use
• Comprehensive
inventory of assets
and
interdependencies
allows for clear
planning and
integration
Key benefits:Dell Business Process Management System dashboards
Review of existing systems
Data and systems integration

22. Dell - Internal Use - Confidential22
Dell Staffing Services
Overview

23. Dell - Internal Use - Confidential23
Solutions
Staff augmentation
services
Managed services
Business process
outsourcing
System conversion
support
Staffing services overview
Dell Staffing Services drives results with innovative, cost-efficient staffing solutions. Team up
with Dell Healthcare to get the staff you need, when you need them, where you need them,
and for as long as you need them.
We can help you
with:
 Customer service staffing and
management
 Front-end processing and data entry
 Eligibility and enrollment administration
 Claims processing and adjustments
 Pend management claims adjustments
 Insurance verification
 User acceptance testing
 Business analysts
 Project management
 Configuration services
 Certified coders
 Quality assurance claims audits
 Consulting services for objective
operational review

24. Dell - Internal Use - Confidential24
Solutions
Staff augmentation
services
Managed services
Business process
outsourcing
System conversion
support
Staff augmentation services
Drive results with innovative, cost efficient staffing solutions.
• Flexible to meet your
project and
budgetary needs
• Trained associates
which decrease
training and ramp-up
time
• Short and long-term
assignments
Key benefits:Comprehensive database of more than 46,000 candidates
More than 30-years experience providing claims professionals to the
healthcare payer industry
Experience with multiple claims systems
End-to-end staffing: mailroom support and front-end data entry, claims
adjudication, audit/overpayment recovery, inbound and outbound
member and provider call center staff
Local on-site, work at home, travel resources, as well as contract-to-hire
and direct-hire solutions

25. Dell - Internal Use - Confidential25
Solutions
Staff augmentation
services
Managed services
Business process
outsourcing
System conversion
support
Managed services
Reduce your administrative costs and enhance operational efficiency. Outsource any or all of
your transactional or call center operations to Dell.
• Dell manages the
day-to-day activity
and outcomes for
performance,
productivity, and
quality assurance
• Integration with
customer leadership
team
• Leverage global
delivery model for
reduced costs
Key benefits:Provides a project management approach
Delivers outcomes/results-based solutions
Leverages customer’s existing systems and technology
Incorporates quality process improvement and management in the
solution
Delivered through Dell service centers or via home processing

26. Dell - Internal Use - Confidential26
Solutions
Staff augmentation
services
Managed services
Business process
outsourcing
System conversion
support
Business process outsourcing
Dell’s end-to-end BPO services for healthcare payers are designed to meet the challenges of
regulatory mandates of the Affordable Care Act and others – the transition to ICD-10 ,
changing member demographics, and rising consumerism.
• Improve member
services and gain a
competitive
advantage
• Decrease operational
costs
• Meet peak demand
for trained resources
during ICD-10
conversion, open
enrollment, or
unexpectedly high
claims or call volume,
through our staff
augmentation
services
Key benefits:Process transformation
Consulting, implementation and managed services
Ready-to-market, standardized solutions
Multi-tenant models for COOPs and ACOs
Global network of professionals in Plano, TX; Lincoln, NE; Chennai,
Coimbatore; Noida, India and Manila, Philippines

27. Dell - Internal Use - Confidential27
Solutions
Staff augmentation
services
Managed services
Business process
outsourcing
System conversion
support
System conversion support
Dell can assist with system selection, implementation, data migration and claim processing
support to ensure prompt payment guidelines are met.
• Helps manage the
cutover expense
related to facility,
equipment, and
staffing
• Reduces time to
return to full
productivity
• Provides flexible and
scalable solutions to
match business
needs
Key benefits:Allows the health plan to focus on system transition, maximizing return
on investment (ROI)
Reduces risk of building claims backlog during system transition
Provides flexible duration
Maximizes new system ROI
Delivered through Dell service centers, remote work-at-home
processing, or customer site

28. Thank you!
Visit Dell.com/HealthPlans to learn
more.
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