|
Feature |
Benefits |
| Track and maintain an unlimited number of Health Plans |
As your organization expands, your ability to add additional plans assures that our application will grow as your organization grows. |
| Track and maintain an unlimited number of Benefit Plans |
This assures that as your organization grows you will not exhaust the application’s ability to add Benefit Plans. |
| Benefits use a simple and easy to use Set structure |
Create it once and use it over again and again. The
eMCee® benefit structure is based on a set methodology which prevents unnecessary’ re-keying and data entry.
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| Benefit Plans can have multiple benefit set criteria |
Benefit Plans can have multiple benefit set criteria · Benefit Sets can be defined as CPT-4 Procedure Codes,
CDT-2 Codes, Diagnosis Codes, Hospital Revenue Codes, ICD-9 Procedure Codes, Type Of Bill Codes, Places of Service, Types of Service, Provider Classes, and Provider Specialties in any combination. · Allows benefit restrictions to be as open or prohibitive as necessary. · In addition, sets can be tied to a specific gender, age range, or relationship to the primary insured.· Benefit Sets can be flagged to require an authorization as well
as deemed covered or not covered under the plan. |
| Flexible definition of benefit limits & restrictions |
Allows dollar or visit limitations to be established per day, week, month, or year. · Lifetime limits can also be defined for each benefit set.· Different benefit levels can be established based on the renderring provider’s or facility’s affiliation with the health plan.· Benefits can be rolled into user defined benefit types where all individual and family annual copay and benefit limits may be established.· Waiting periods may be established for each benefit type where a member must be eligible with a given health plan for a defined period of time prior to receiving benefits. |
| Ability to define a variety of patient pay schedules |
Copay schedules can be attached at a benefit set level.· Copay amounts or percentages can be established based on place of service, provider class, and/or the provider’s affiliation with the health plan. · Tiered copay schedules can also be created whereby different copay amounts may be established based on the number of visits the member has accumulated for a particular benefit.· Copay logic may be established at the plan level whereby the system will use the first, greatest, or all copay amounts calculated for a given claim.· Various Deductible and Co-Insurance percentages and limits can be established based on the provider’s or facility’s affiliation with the Health Plan.· Certain benefits can be set up to apply or not apply Co-Insurance percentages or Deductibles· Accumulated Deductible and Co-Insurance amounts can be carried over into the next benefit year if the member joined the Health Plan near the end of the benefit year. |
| Automatic incrementing of all accumulators |
All benefit limitations defined are stored
and updated for each member for individual benefits and on the primary member for family related benefits.
What each member or family has accumulated can be view within our
member module. Ensures benefit restrictions put in place are accurately enforced.
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