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Group Health Claims Processing - Proven to reduce costs by 25%
The Group Health module offers comprehensive bill adjudication and reprices them to any fee schedule or provider panel.
Features and Benefits to consider:
- Process Group Health, as well as STD/LTD
- Can cut employers cost by 25%
- Especially for self insured of any size
- Automatically tracks HSA, HRA and employer defined trust accounts
- High deductible solution
- Eliminates the usual medical provider and employer work flow of processing claims
- Utilizes virtual accounts to cover the insured deductible component
- Employer defined limits and coverages
- Combined with QuickPayNET™ obtains substantial discounts from hospitals and providers
- The final solution to employee utilization of health care resources
- Combines all the modules and advantages of the workers comp system
- Enables administrators to view all claims of an insured, i.e. workers comp, STD/LTD, P&L and group on one system
- Integrated medical case management and utilization review
Additional System-Wide Features:
| Web-Based: |
Our web-based technology empowers your Workers Compensation bill review process with up-to-the-minute information on claims, providers, payments, databases, tables and schedules ensures your bill re-pricing will net the absolute maximum savings allowable. |
| Bill Re-Pricing & Review, Clinical Edits |
Extensive, customized and MCCI clinical edits. Case management authorizations automatically adjudicate bill line items, state fee schedules, PPO’s, build a table of protocols and authorizations by Dx, CPT Dx group codes. Auto build any UCR fee schedule by percent of state Medicare/Region. |
| PPO's: |
30 PPO's Loaded On System plus a National Pharmacy PPO |
| Case Management/ URAC Accreditation: |
Authorizations, utilization review, procedure tracking, cost savings tracking for all aspects of care, notes by type, work queue diary & calendar, fax & email from system, forms generation, letter generation and auto entry to notes. Can be used for Group Health claims management. |
| Plan of Care: |
Multiple plans by Dx with begin & end dates, customized assessments, 30 day return to work, RAW medical plan, etc... Conforms to URAC data collection. |
| Utilization Review: |
Tracks outcomes and savings by admissions, automatic review for cases flagged. Can also be used for Group Health claims management. |
| Reporting: |
Hundreds of reports may be run by many sorts, customized reporting. |
| Data Downloads |
Run presorted data downloads to use with any report writer, auto downloads encrypted files and selected data to your local drive for import. |
| Forms Management: |
Any form printed on plain paper at any printer with system data merged on to form. Date and time of form generation captured to notes file. |
| Check Printing: |
Select pay from account by parent, group, employer, or by type of payment. Medical checks batched by provider by employer with EOB attached or additional forms printed, collated forms on printer using several paper draws, copies of checks, no preprinted checks used, use most any existing printer, secure, any number of accounts and checks, outsource and more... |
| Document Imaging, Email & Fax Fully Integrated Into Applications & Work Queue |
Work flow, audit trail, routing, notes, stamps, email & fax. Fax
images, forms, and reports in text or PDF format, directly
from system. Capture fax and email transactions into notes
file automatically. Internet email from the Claims Advantage™
System has your company reply to email address. |
| MODM (Measure Of Disability Management): |
Return to work benchmarks by Dx code, work class code, gender & age; reports, on screen queries and automatic work queue notification when close to well managed RTW benchmark. Helps you measure case management effectiveness. |
| Pharmacy Benefit Manager: |
Saves 15 - 40% off of state fee schedule, no effort on customer part, all pharmacy data captured on Claims Advantage™ system for approval, authorizations faxed directly out of system to Pharmacy. You pay only if you save. |
| Electronic Banking: |
MCO centralized claim form & FROI input center, cuts your costs; HIPPA and URAC certification staff to help you obtain approval. |
| Policy Administration: |
Policy issuance, rating, and premium billing & collections. Financial trust reporting and administrative payments |
| Case Management: |
Case Management Time Billing and Collection |
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