Claims

Specific claims and 50% notifications are logged, audited and reimbursed.

Audit Specific claims on a detail line-by-line basis, or in aggregate
Track plan co-pays, deductible, and co-insurance
Track and automatically reduce reimbursements for Aggregating Specific and Split-Funding
Track individuals who are Disclosed and/or Lasered and automatically reduce reimbursements for Lasers
Pay Loss Adjustment Expenses
Account for Cost Savings achieved by case management and negotiations
Account for PPO Discounts by PPO Network
Account for charges paid by Provider to allow analysis for claims paid at each facility
Document and report on Pended and Denied Charges
Establish and manage reserves by claimant
Track claims by Administrator and Auditor for activity and turn-around time
Report claims and reserves to Carriers and Reinsurers

Aggregate reporting based on monthly group aggregate reports, auditing and reimbursement.

Manage Aggregate claims paid by multiple benefits and aggregate factors, including medical, Prescription Drugs, Dental, Vision and Weekly Income
Pay Loss Adjustment Expenses
Document and report on Pended and Denied Charges
Track claims by Administrator and Auditor for activity and turn-around time
Report Attachment Point accumulation and reserves to Carriers and Reinsurers

Request and pay claim reimbursements.

Print Reimbursement Checks
Print an Explanation Of Reimbursement along with each check
Account for voids and credit and claim refunds
Reimbursements are included on the claim bordereaux for Carrier and Reinsurer reporting
Establish claim payment authority levels by claims auditor
System checks for issued policies and current premium prior to reimbursement
Auto-referrals to alert claim management teams for trigger diagnosis and high dollar claims

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