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Our claims adjudication system combines integrated
software design with the latest advanced technologies. Although the design
is global in scope, the user-defined system approach enables Activa™
Benefit Services to customize the system parameters to meet the
requirements of our specialized client base.
Our systems combine the
functional responsibilities of Activa™ Benefit Services operation by
seamlessly integrating the areas of Claims Administration, Group Billing
and Administration, and Accounting.
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Advanced Features &
Benefits of our Information Technology Solutions
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- Laser Form and Check Printing
- All forms, including magnetically encoded checks and the Explanation
of Benefits (EOB) are laser printed on stock paper. The system
automatically prints checks with the required bank MICR numbers and
required signatures depending on the specifications of the plan being
administered by Activa™ Benefit Services
- Comprehensive Database
- Files have been designed to capture all relevant data pertaining to
plans, groups, participants and providers. Files can be accessed for
claims processing, utilization reports or plan modeling to access
changes in benefits or assist in direct negotiations with providers.
Expert System- Our solution contains an expert system module which automatically
adjudicates all claims on a uniform, consistent basis exactly as the
most experienced examiners do. The module performs many more checks to
each claim than is feasible even for the most diligent claims
examiner. The system can be prompted, on a step-by-step basis, to
display the logic it uses to adjudicate claims. This allows examiners
and claim representatives to be highly responsive to customer
inquiries regarding specific claims.
Document Imaging- Integrated imaging technology transforms claims processing from a
highly paper intensive activity to a truly paperless function. All
claim related documents are electronically stored and can be retrieved
at any time for video display or laser printing. Imaging eliminates
the need for manual sorting, stamping, filing, and retrieval of
documents.
Participant Tracking- Our system tracks historical claim activity for every plan
participant, including images of all EOB's, correspondence and claims
related documents, and a log of all phone calls related to claims
activity. This feature allows users to instantly respond to telephone
inquiries rather than sort through voluminous paper files.
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- Reporting
- Our reporting system provides comprehensive operational and
management reports to measure and control the costs of the claims
processing operation and the cost of the health care provided. The
health care management reports, in particular, provide Activa™
Benefit Services with a tool for the measurement of a wide variety of
cost containment strategies.
Electronic Data Interface- We can accept a variety of EDI formats and automatically import
claims information into the system workflow.
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- Charges are verified on-line through the use of the a database
which automatically checks the charges for surgery, radiology,
laboratory and office visits. These claims will be paid on the 90th
percentile level.
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