Group Health

Smart Claims Management

Software and human support that converts complex claim processing into clear, accurate information that is designed to meet all requirements and deliver accurate payments across the board in record time.

One-Stop-Shop

We pride ourselves on creating the smoothest workflow to optimize our clients’ revenue and processes. We manage and disperse over $7 million in claims each month, with a turnaround time of 1-2 days. All adapted for each client to meet contractual requirements and parameters.

Comprehensive
Ability to convert, translate, and correct a large volume of claims from submission to reimbursement. As a vendor for delegated entities with large group health payors, we are uniquely qualified to handle the often complex rules and translate inbound claims to payor-specific billing and coding requirements. Financial modules designed to meet the highest standards and Generally Accepted Accounting Principles (GAAP) contribute to our client’s records of excellence and compliance under delegated entity agreements with large group health payors and with annual audits.

Accurate
With over 25 years of experience, our team is skilled at processing data to meet your specific parameters and contractual requirements.

Fast
Strict adherence to rule-driven parameters means we can process clean claims in as little as 1-2 days.

Transparent
See and review all bills, records, transactions, and other paperwork in your custom portal. Everything – to the penny – is visible and available in real-time whenever you need it.

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Our Services

Fee for Service (FFS)

• Translate claims to conform to contractual requirements.
• Capture and retain original inbound billing information and outbound translated details within the same claim record.
• Apply appropriate payments to providers based on client parameters.

Capitation (CAP)

• Process claims in accordance with client-specific capitation rules.
• Submit encounter data.
• Disburse payments in accordance with client-specific reimbursement parameters.

Technology and Capabilities

• Accept claims through multiple clearinghouses in HIPAA compliant or proprietary format.
• Export claims via multiple clearinghouses in HIPAA compliant or proprietary format.
• Enable real-time access to bill status, images of bills and medical records, payment information, processing history, and reports through web portal.
• Generate payment data to clients or disburse payments to providers.
• Generate custom Explanation of Payment (EOP).