Medical Benefits Administration Software

The first Medical Electronic Claims Processing Software and Benefit Administration System to combine leading edge database technologies, ease of use, built-in document imaging, and direct web access integration in a single solution. HIPAA and Medicare compliant, this software allows for medical claims processing and electronic medical claim submission while also providing a complete medical claims management system.

ClaimScape medical benefits administration software is designed to improve benefits administration while reducing costs by streamlining the processing and administration of medical claims.  This product provides complete benefit administration, medical claim processing, and reporting features

ClaimScape offers a variety of technical services. With a team of talented leaders and developers, ClaimScape provides valuable services to its customers, including custom software development, TPA software, electronic health claims filing, web site and application design, and various consulting services in data management, network integration, and more. For more information about our services, please contact us.

Advanced Features Include...

• Streamlined Workflow and intuitive user interface for quick access to information.

• Full benefits administration including medical, dental, vision and hospital claims processing.

• Rich, high performance reporting for at-a-glance access to the information you need in just a few keystrokes.

• Integrated imaging allows one-click access to claims, attachments, and authorizations while processing claims or assisting the insured.

• Advanced correspondence logging for single click access to Word documents, emails, or Excel spreadsheets previously sent to clients or insureds.

• Direct integration with ClaimScape HCFA and UB92 Automated Scanning System for quick claims turnaround and minimal data entry.

• One click viewing and scanning of Client's Plan Docs, DOFR's, and amendments for rapid response to complex benefit questions.

• Rich, high performance reporting for at-a-glance access to the information you need.

• Full HIPAA compliance including security tracking, patient security features, and acceptance of all HIPAA data formats.

• Advanced Microsoft .Net and SQL 2000 architecture for security and scalability.

• Real-time integration with administrative web site for instant access to claims status and eligibility via the web for insureds and providers.
  
  

Complete Benefit Administration

Full featured benefits administration system that allows automation of all benefit plan types and one-touch access to scanned benefit plans, amendments, and DOFRs.

Automated Claims Processing

Automated claims calculations from claims entered, scanned, or received via EDI gateways. Streamlined screens provide access to process all information needed to rapidly and correctly process claims.

Advanced Customer Service

Advanced note-keeping, reminders, phone call logging and correspondence processing with one-touch links to word processing documents or spreadsheets make Customer Service a breeze.

Case Management & Referral Processing

Features extensive detail tracking of referrals, pre authorizations and inpatient stays, and other ancillary services. Daily level of care and outcome management.

Capitation Processing

Capitation system for HMO, MSO, and IPA models automates capitated as well as fee for service claims.

Contract Administration

Powerful contract administration features allow extensive provider contracts and fee schedules. Support for custom and national standardized fee payment system.

Flexible On-Demand Reporting

Impressive reporting system includes over built-in reports with one-touch exporting to PDF, Excel, and more. Multiple selection criteria for each report allows you to zero in on the information you need.

Premium Billing

Detailed premium invoicing system allows tracking of insured premiums and fees by location including medical and dental premiums, reinsurance and broker fees as well as automated credits and debits.

Integrated Web Access

Integrated Web access interface allows providers, insureds, and group administrators instant access to status of claims, eligibility and referrals.

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Integrated HCFA & UB92 Claims Scanning

Integration with CLAIMSCAPE Claims Scanning system allows HCFA and UB92 claims to be scanned and automatically imported to claims system, dramatically decreasing user data entry and improving claims turnaround.