| We process medical, dental,
vision, flex and disability claims. Our experienced claim professionals
utilize Eldorado Computing, Inc., software modules customized
to our specifications. This state-of-the-art, fully automated,
on-line, real-time system provides instant claim and eligibility
information and provides exceptionally efficient claims and
encounter processing of even the most complex transactions.
Our system automatically adjudicates many claims.
Electronic and paper claims with complete information that
do not automatically adjudicate are processed within 10 business
days. Claims that require additional information are pended
and tracked in our system.
We strive to process claims with 100% accuracy. Our audit
policy, training program and systems are designed with this
in mind. We conduct mandatory prepayment audits for claims
exceeding designated dollar amounts. Further, we conduct random
audits of 3% of other claims.
Network claims are re-priced according to the negotiated
fee schedule. Non-network claims are subject to usual and
customary fee schedules provided by Ingenix, formerly Medicode.
Further, some non-network claims are negotiated.
Checks for benefits to the covered person and/or provider
are issued, along with a detailed explanation of how the benefit
payment was calculated, using laser-printing technology. Claim
payments for self-funded plans are issued from a special claims
bank account either managed by our accounting staff or by
our client. Claim payments for insured plans are made from
bank accounts of the insurance company. |
