ClaimScape Health Benefits Administration Software
ClaimScape also offers various technical services including customization to meet the specific needs of most health claims administration companies. With a team of talented leaders and developers with extensive knowledge of the health benefits field, ClaimScape can provide customization tailored to providing maximum efficiencies to address the need of your insured clients, provider groups, and health plans.
Advanced Features of ClaimScape Health Benefits System
Include...
- Ease of Use for Minimal Training Time
- Simplified Eligibility Processing
- Integrated Scanning and Document Management
- Built-In Electronic Pre-authorizations and Scanned Claims support
- Advanced Claim Adjudication with Automated Processing
- Instant On-Screen Reporting
- Integrated Pre-Approval & Case Management Workflow
- Rapid and Flexible Benefit Plan Setup
- Built In Document Imaging for document access related to provider, group, and insured members
- Customer service call and correspondence tracking including one touch SMS or email to caller
- Rapid Pre-authorization Queue Processing from Electronic or other links
- British and American Date Support
- Real-time Web Access for Insureds, Providers and Groups
- Support for International Markets and Currencies
- Cost Effectiveness and a Predictable ROI
- Open Architecture Databases for access by Third Party Applications
- Single Server or Clustered Server Support
- Scalable to Millions of Insured Members
- Multi Level Group Security with logging of all events
- Multiple Company , Multiple Database Support
- Claims , Preauthorization, and Customer Service Queues for maximum efficiency and optimized workflow
- Support for Non Standard Provider Codes and Fee Schedules
Complete Benefit Administration
Automated Claims Processing
- Claims Workflow queue for rapid processing from multiple sources including batch entry, EDI and Web
- Advanced Claim Adjudication with Electronic Processing
- Entry of Claims by Batch Entry, Manual, Electronic Queue or EDI Files
- Automated Claims Analysis of proper payment from Provider with rules database of 3.5 million rules ( CPT Codes)
- All user claims messages into Single Window to allow quicker claims entry and require user to view one window instead of several while processing claim
- Automated Claims and Document Scanning
Advanced Customer Service
- Built In Document Imaging for document access to provider, group, and insured related documents
- Rapid Searching for Insured, Claim, Preauthorization and Provider Information
- Customer service call and correspondence
- SMS or email to Responses to callers
- Streamlined Customer Servicing with multi window support
- On-Screen Phone Log and Customer Service Queue
- Route to Supervisor Capability
- Advanced Correspondence Logging with One Click Links to Original Document
- Instant Links to Word, Excel and Outlook with Auto Fill Letters and Correspondence
- One Touch Access to Plan Docs, Claims and Original Patient Records
- Utilization Review and Case Management
- Simultaneous Access to Multiple Patient Screens
- Handy Correspondence Tracking and Pop Up Notes and Reminder System
Referral Processing and Preauthorization
- Built -In Electronic Pre-authorizations and Scanned Claims
- Preauthorization Workflow Queue for rapid processing of Pre-authorizations received from multiple sources
- Integrated Pre-Approval & Case Management Workflow
- Rapid Preauthorization Queue Processing from Electronic or other links
- Built -In Support for Electronic Pre-authorizations and Scanned Claims
- Automated Process for Claims and Pre Approvals allows High Speed turnarounds
- Pre-authorizations and Referrals directly Linked to Claims
- Streamlined Preauthorization Processing Queue
- Track Referrals, Pre-authorizations and Complete Hospital Stays
- Preauthorization Submission from Internet
Flexible On-Demand Reporting
- Instant On-Screen Reporting
- Instant EOBs and Quick Summary Reports
- Export to PDF, Word or Excel
- Wizard Style Parameter Selection for all reports
- Dozens of Sub Reports and Sorting Options
- Benefits Report by Service Code, Procedure Code, Disease Type
- Employee Census by subtotals by benefits, by location, by nationality
- Book Of Business Group Summary
- Claims Summary by Insured Member
- Claims Summary by Provider including Top Ten Provider
- Claims Summary by Amounts Paid Thresholds
- Hospital Inpatient Stays Summary
- Claims Detail Reports with Provider, Benefit , Reason Code filters
- Claims Processing Production Report by Examiner , By Hour, By Group
- Phone Call Tracking reports by Hour, by Customer Service Representative, by Call Category
- Follow Up/Reminder Reports
- Inpatient Hospital Stay Census Report
- Claims Paid by Month During Policy Period Report
- Claims Paid Turn Around Report
- Claims Cost Per member Report for Premium and Paid Claims
- Pending Clams Report
- Account Receivable Insured and Group Reports
- Billing Summary Report for Insured and Group Billings
- Eligibility Status Changes Report
- Hospital Utilization Report
- Average Paid by Age Band Report
- Claims Lag/IBNR Report
- Security Logging reports
Premium Billing
- Complete Premium Invoicing
- Tracks Retro Adds and retro Terms with Automatic Adjustments
- Rates by Group, by Benefit Plan, by Member Relation
- International Support for Rating by Nationality, Age, and Gender
- Monthly, Quarterly, or Annual Premium Invoice
- Support for PPOs and TPA/Administration Fees
Integrated Web Access
- Electronic Medical claim submission
- Electronic Preauthorization submission
- Instant Access to Plan Documents, Policies, and Monthly Reports
- Managed entirely from within ClaimScape application. No programming required
- Real Time Web Access System for Insureds ,Groups, and Provider
- Access Eligibility and Claims Status from Anywhere, Anytime
- Detailed Claims Information and Pre-Approval Status
- Detailed Eligibility Information and Status
- On-Line Preauthorization Submission for Providers
- On-Line Enrollment , Additions and Terminations
- On-Line Submission of Claims Batches from Providers
- On-Line Status checks for providers of Claims, Pre-authorizations, and Eligibility
- Detailed Benefit Plan Information
- Quick Links to Health Information Sites
- Insureds can make or request changes on-line
- Access to benefits documents, general information, or provider contracts
Integrated Claims Scanning
Standard Formats
- High Speed Processing of HCFAs, UB92s and other Claims Forms
- Automated On-Screen Verification of Claims Data using Real-Time Validations into Existing Databases
- Access to Images via Web Image Viewer or Direct Export into your Existing Claim Systems
- Export of Data into EDI formats or directly into your Existing Claims System
- Unlimited Scalability from Hundreds of Forms a day to Tens of Thousands with Multiple Scanners and Locations
- Custom Templates Available for any Claim Format
- Adaptable to Automated Eligibility Processing or other documents
International Formats
- System can scan and recognize any claim, any format, any attachment, and any size.
- Maximizes Claims processing throughput
- Allows instant access to claims images – All claims images are viewable anytime by coding person, claims adjudicators, and customer service person from ClaimScape as well as from the Web Access System
- All claims and attachments are stored as PDF and permanently embedded with Date Received, Claim ID, Batch Number or any custom stamp
- Claims Adjudicators and Claims Coding Specialists do not need to have the paper claims at their desks
- Any claims form can be used, since no predefined templates form required
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