Members Management

Members Database

Cover/Product Database

Group & Individual Contribution Billing

Agency Administration Module (Optional)

Customer Service Notes System

Correspondence Module Features

Claims Processing Modules

Claims System Versatility

Claims Administration & Assessment

Claims System Summary

Reasonable & Customary Charges

Electronic Claims Processing

Dental Claims Module

Pharmaceutical Processing Modules

Claim Adjustment & Cheques Cancellation

Cheques & Remittances Advice

Report & File Generation



Electronic Claim Processing
Allow providers to submit claims electronically and assess them automatically
Electronic Data Interchange (or EDI) allows providers to submit claims electronically to a clearinghouse (such as HICAPS or IBA Health Point) where they are electronically transmitted to each Fund.  Funds then have the option to assess the claims on-line or automatically.  Automatic assessment allows claims to be assessed with little or no assessor intervention.
Significant Strengths


Supports on-line, batch, or electronically entered claims.

Supports two different methods of assessment on-line or automatic.

Supports a large number of system and user-defined edits in the automatic assessment process.

Eliminates assessor intervention on many claims.

Processes a series of management reports that indicate the results of all automatically assessed claims.

Registers all claims prior to processing.



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