Evolent Health Services

Next Generation Core Administration

Drive Operational Efficiency With A Powerful Suite Of Back Office Services And Capabilities

Evolent Health Services partners with health plans and risk-bearing organizations by providing core administrative services, powered by a modern and integrated platform.

With 20+ years of experience, our core administrative suite eliminates unnecessary cost by integrating and simplifying administrative operations.

Claims Processing

We have more than two decades of experience successfully processing claims. Our proprietary and rules-based claims processing platform provides flexible configuration by plan, fee schedule, provider and provider service location.

Credentialing & Provider Data Management

Our deep experience working alongside providers to credential and re-credential minimizes provider abrasion, while meeting all state and federal requirements. Evolent’s integrated provider data management solution ensures accuracy across all applications, including claims, reporting and provider payments. 

Customer Service

We maintain in-house, full service, US-based customer service contact centers to support members and providers. Customer service representatives are trained to understand the nuances of our partner markets.

Encounters Management

We ensure accurate, complete and timely encounter data submissions across all managed care programs and lines of business. 

Enrollment & Eligibility

Member access to care is our priority. We deliver timely processing of eligibility files to ensure fulfilment of Member Information Packets and member ID cards.

Finance & Accounting

We offer all required accounting and financial management functions for our partners, including cash management, premium billing, funds flow, general ledger accounting, pro forma and financial statement generation, budget analysis and treasury support services.

Health Plan Portals

Evolent's configurable and interactive Member, Provider, Broker and Employer portals connect front and back office operations to provide a seamless experience for every health care user.

Payment Integrity

Leveraging claims data, plan payment requirements and provider contract details, we identify opportunities to maximize recoveries. Our services include FWA, COB, DRG auditing, data mining, subrogation, credit balance and SIU.

Evolent Health was recognized in Gartner’s 2020 Market Guide for U.S. Healthcare Payers’ Core Administrative Processing Solutions*

Core Capabilities That Drive Results

State and CMS encounter acceptance rate

Customer Service speed to answer in 30 seconds

Claims auto adjudication rates

Learn More About Our Core Administrative Services & Capabilities

 

*Gartner does not endorse any vendor, product or service depicted in its research publications, and does not advise technology users to select only those vendors with the highest ratings or other designation. Gartner research publications consist of the opinions of Gartner's research organization and should not be construed as statements of fact. Gartner disclaims all warranties, expressed or implied, with respect to this research, including any warranties of merchantability or fitness for a particular purpose.