Claim Adjudication Simplified Across All Lines of Business - Medical, Dental, Vision.
Claim Adjudication Simplified Across All Lines of Business - Medical, Dental, Vision.
Advanced Provider Matching Logic from submitted claim data to industry standard files or custom provider uploads
Member Matching algorithms with Member Aliasing to reduce Member Not Found and Eligibility Errors
Claim Pricing for professional and facility claims. Handling Fee For Service, Capitation, Carve Outs, DRG Pricing, Case Rates and others.
Custom Edits to ensure accurate Benefit Administration and claim adjudication accuracy
Process Deductible, Out of Pocket Maximums and coordinate with all your partners
More advanced over claim edits that allow handling of frequency based counters, such as X Number of Visits
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