The client is a USA based healthcare insurance provider and claim processing house having other 8 companies under the umbrella, each working independently towards providing services in US healthcare. The company specialises in providing software solutions in the area of claim management, medical bill review, policy administration, risk management.
All processes related to bill review and claim management did not have a streamlined and maintained process flow. This resulted in poor financial planning and dependencies in processing employees’ medical. We are working as their technical arms for solution development, maintenance and customisation.
The customised solution for risk managers and insurance companies offers an integrated approach towards claim management and policy administration on medical expenditure for different user groups
The system offers multiple bills and claims entry methods including EDI imports in multiple formats, traditional keyed inputs, image scanning, etc.
Online image and document storage for each bill and claim data processed
EMB Coded review explanations for each adjustment
One-click CMS reporting, retrieval, and correction for medicare
The system supports payment scheduling, reminders and alerts, and extensive claim notes for tracking integrity
EOR formats in printed, digital image, or digital transmission formats
Improved and controlled bill review and claims management