Successfully administer plans across multiple lines of business. Achieve greater levels of operational efficiency and plan for future needs with a dynamic and flexible claims administration system. Our easily configurable, cloud-based claims processing and adjudication solutions for commercial, Medicare, and Medicaid markets reduce the cost of technology ownership and allow for rapid implementations.
On average, we process 98.5% of claims within 30 days, financial accuracy at 99%, and statistical accuracy at 100%.
We integrate numerous claims formats with ease. You can specify parameters or rules according to CMS processing guidelines, payment methodology, and individual health plans. You can also accurately process, pay, and store claims and claims payment remittance advice/EOPs/EOBs. Our solutions allow you to: Lower administrative costs to better meet the medical loss ratio and other regulatory requirements.
- Increase the accuracy of your claims adjudication rates
- Integrate claims edit and re-bundling
- Manage complex benefit and reimbursement methodologies
- Complete HIPAA compliant transactions
- Eliminate paper workflow
- Batch claim re-processing for specific providers, contracts and various bulk criteria
- Configure fuzzy logic such as check duplications and authorization matching
- Print Claim and Capitation checks
- Improve claim queues and workflows