|
Feature |
Benefits |
| Well
Designed Claim Modules |
When
not electronically importing claims, manual entry of professional,
facility, and dental claim is facilitated via shortcuts, business
rules, and superior design |
| Claims
can be adjudicated in batches or per claim |
The
most finite or global claim batches can be created via a myriad of
claim selection criteria. When desired claims can be adjudicated
individually with a click of a button located on each claim form |
| Manual
Adjudication |
With
proper security, users can override adjudication to handle special
exceptions |
| Multiple
Rules/Edits |
Adjudication
performs 330+ edits and checks per service all in a matter of
milliseconds. All eligibility, coverage, and contract
determination is done in a single process |
| Claims
statuses are tracked as they move through the adjudication process |
Claims
status is automatically determined by the system.
For instance, claim detail lines will show denied, held,
batch, capitated or paid.
This provides your organization valuable information when
generating EOB reports |
| Reversals |
Reversals
and Adjustments are clearly marked on each claim |
| Group
claims to be worked |
Claim
entry personal can search for and group all denied or held claims
to research and work at one time. |
| Multiple
Rules/Edits |
Adjudication
performs 330+ edits and checks per service all in a matter of
milliseconds. |
