ClaimScape Health Benefits Administration Software
ClaimScape is the first Medical and Health Benefits Claims Processing Software System to combine leading edge database technologies, ease of use, built-in document imaging, automated claims scanning and direct web access portal integration into a single solution. HIPAA and Medicare compliant, this software allows for medical, dental, vision , hospital, claims processing and electronic medical claim submission while also providing a complete medical claims payment system.
ClaimScape medical benefits administration software is designed to automate benefits administration while reducing costs and streamlining the processing and administration of medical and health claims. This product provides complete benefit administration, claim processing, preauthorization processing ,customer servicing , call tracking , provider contract management and reporting features.
ClaimScape Technical Services Division offers an extensive variety of technical services including customization to meet the specific needs of most any health claims administration company , IPA, or TPA . With a team of talented leaders and developers with extensive knowledge of the health benefits field., ClaimScape TSD 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...
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.
Automated PreAuthorization Workflow for high speed processed of preauthorization's received by fax or electronically.
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 insured.
Direct integration with ClaimScape HCFA and UB92 Automated Scanning System for quick claims turnaround and minimal data
entry.
International features for compatibility with world markets.
View Claims Images and Attachments while processing.
Automated Electronic Claims Queue Processing for Streamlined processed of claims received by EDI Files , Scanning
System, or XML Portal.
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.
Open Architecture Database design allows access to data by your existing applications or reporting tools.
Full HIPAA compliance including security tracking, patient security features, and acceptance of all HIPAA data formats.
Advanced Microsoft .Net and SQL 2005 architecture for security and scalability, 5 users to 5000 users.
Real-time integration with ClaimScape Web Access Systemsite for instant access to claims status and eligibility via the web for insured 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 or XML portals.
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. Streamlined Pre-Approval workflow queue.
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 and easy to use report wizard 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.
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.
