Sapphire Consulting Group is all about cost containment and fast-paced developmental plans for your business. We will transform your company and implement the necessary changes to make your business goals.

Our Key Services:

  • Strategic Business Alignment:
    • Develop a robust strategy tailored to align with your unique business goals.
    • Execute strategies that enhance operational efficiency and foster sustainable growth.
  • Cost Optimization:
    • Reduce cost per member through strategic cost management initiatives.
    • Lower administrative costs without compromising on service quality.
  • Claims Management Excellence:
    • Improve auto-adjudication with advanced claims management solutions.
    • Integrate claims systems for efficiency and accuracy.
  • Provider Data Enhancement:
    • Improve provider data accuracy and reliability.
    • Streamline credentialing processes to ensure compliance and quality.
    • Improve Provider Enrollment
  • System Maximization:
    • Maximize core and ancillary systems for enhanced operational performance.
    • Optimize operations through the integration of cutting-edge technologies.
  • Credentialing Process Improvement:
    • NCQA readiness
  • Network Expansion:
    • Contract providers strategically for network expansion.
    • Implement value-based payment methodologies, shared savings, and bundle payments.
  • Claim System Configuration
    • Improve system configuration for products and process.
  • Business Expansion and Consolidation:
    • Expand and consolidate new lines of business with a focus on sustainability.
    • Optimize operations to ensure a seamless integration of expanded services.
  • Program Development & Training:
    • Develop and implement programs for sustainable growth.
    • Provide comprehensive training for effective program execution.
  • Network Development and Operations:
    • Optimize provider services, contracting, and credentialing.
    • Turn around health plans through strategic interventions.
  • Standard Operating Procedures:
    • Develop and implement standardized operating procedures for streamlined processes.
    • Evaluate staffing models to meet the unique needs of clients and service line agreements.
  • Quality Assessment:
    • Review the quality of primary, secondary, and tertiary care services.
    • Assess total PMPM cost, utilization rates, and cost per elected episodes for continuous improvement.
  • Mergers and Acquisitions Management:
    • Navigate the complexities of mergers and acquisitions with confidence.
    • Streamline the process to ensure a seamless transition and maximize value.
  • Improve Provider and Member Appeal process

At Sapphire Consulting, we are committed to driving positive change in healthcare operations. Partner with us to unlock the full potential of your organization and achieve sustainable success. Contact us today to embark on a journey of innovation and excellence.

Our Key Services:

  1. Strategic Business Alignment:

    • Develop a robust strategy tailored to align with your unique business goals.
    • Execute strategies that enhance operational efficiency and foster sustainable growth.

  2. Mergers and Acquisitions Management:

    • Navigate the complexities of mergers and acquisitions with confidence.
    • Streamline the process to ensure a seamless transition and maximize value.

  3. Business Expansion and Consolidation:

    • Expand and consolidate new lines of business with a focus on sustainability.
    • Optimize operations to ensure a seamless integration of expanded services.

  4. Cost Optimization:

    • Reduce cost per member through strategic cost management initiatives.
    • Lower administrative costs without compromising on service quality.

  5. Claims Management Excellence:

    • Improve auto-adjudication with advanced claims management solutions.
    • Integrate claims systems for efficiency and accuracy.

  6. System Maximization:

    • Maximize core and ancillary systems for enhanced operational performance.
    • Optimize operations through the integration of cutting-edge technologies.

  7. Provider Data Enhancement:

    • Improve provider data accuracy and reliability.
    • Streamline credentialing processes to ensure compliance and quality.

  8. Network Expansion:

    • Contract providers strategically for network expansion.
    • Implement value-based payment methodologies, shared savings, and bundle payments.

  9. Program Development & Training:

    • Develop and implement programs for sustainable growth.
    • Provide comprehensive training for effective program execution.

  10. Quality Assessment:

    • Review the quality of primary, secondary, and tertiary care services.
    • Assess total PMPM cost, utilization rates, and cost per elected episodes for continuous improvement.

  11. Network Development and Operations:

    • Optimize provider services, contracting, and credentialing.
    • Turn around health plans through strategic interventions.

  12. Standard Operating Procedures:

    • Develop and implement standardized operating procedures for streamlined processes.
    • Evaluate staffing models to meet the unique needs of clients and service line agreements.

At Sapphire Consulting, we are committed to driving positive change in healthcare operations. Partner with us to unlock the full potential of your organization and achieve sustainable success. Contact us today to embark on a journey of innovation and excellence.