COMPLETE CLAIMS OVERVIEW

METHODOLOGY:

Plan or Contract Year structure Benefit Logic:

Utilizes: CPT's, ICD-9's, DRG's, HCPCS, fee schedules, CRV's and others.

Provider fee schedules

PPO fee schedules and on-line repricing

Complete recall - system can report all changes, how a benefit was paid 5 years ago as well as last month and by whom.

  • Pre-registration (optional)
  • Automatic Adjudication (optional)
  • Capitation processing
  • Per occurrence tracking
  • Physician Referral tracking
  • Coordination of Benefits
Processor alerted to:
  • Pre-registrations
  • Pre-certs
  • COB
  • VIP
  • Claimant notes
  • Dependent notes
  • Family notes
  • Provider notes
  • Student status
  • Over % of specific stop-loss
  • COBRA status

Adding new business is simple and cost effective. You can set-up a new plan in less than a day and be paying claims when enrollment is in.

Customer Inquiries may be performed by a processor without interrupting the claim they are currently processing.

Press a hot key and any existing claimant's or enrollee's records are available, answer the inquiry and hot key back into the claim in process.

Claim can be re-opened at any time for reprocessing up until the check is printed.

EOB's may be printed for any past time frame.

COMPLETE WEBACCESS OVERVIEW

Highlights of CompleteWebAccess

  • Fully secure web access with 128-bit SSL encryption technology.
  • Real-time access to claim and benefit information for members, dependents, providers and employers.
  • Simple, easy and secure sign up process to create a web account.
  • Access to claim and benefit information 24 hours a day, 7 days a week.
  • Save time and money with online access to information you need, when you need it.
  • Go paperless with online access to printable EOBs (explanation of benefits), billing statements, reports etc.

What can Members and Dependents do with CompleteWebAccess?

  • Real-time access to eligibility and claim information at the click of a mouse.
  • View, Print and Save EOB's at your home or office.
  • View a copy of the summary plan document online.
  • Access individual and family balances for the current and previous years.
  • Make member enrollment changes using the enrollment section.
  • Stop receiving paper EOB's. View and print them online instead!
  • Ask questions about claims, eligibility etc and receive answers online.
  • Request replacement ID cards.
  • Print temporary ID cards for immediate use.
  • Find an in-network doctor or hospital in your area or elsewhere. Get map and driving directions to provider address too!

What can Providers do with CompleteWebAccess?

  • Real-time access to eligibility and claim information of members and dependents.
  • Access to coverage and balances of members and dependents.
  • View, Print and Save EOB's at your computer.
  • Ask questions about claims and receive answers online.
  • View a copy of the summary plan document online.
  • Submit claims for pre-determination of benefit estimates. Estimation results available online immediately in most cases!

What can Employers do with CompleteWebAccess?

  • Enroll new employees and their dependents.
  • Modify enrollment information of members and their dependents.
  • Request replacement ID cards for members.
  • Verify and approve/reject new enrollments as well as enrollment changes made by members.
  • Receive billing statements, documents and reports securely from the plan administrator.
  • Real-time access to eligibility and claim information of members and dependents.
  • Run and print reports like Checks Pending Register, Employee Census Report etc from the web.

What can Plan Administrators do with CompleteWebAccess?

  • Verify and approve new web accounts for employers and providers.
  • Receive e-mail notification upon employer signup, provider signup, request for ID card etc.
  • Send messages and file attachments like billing invoices, reports, documents etc to employers.
  • Receive approved enrollments from employers securely as EDI X12 834 files.
  • Receive EDI X12 837 files securely from Providers.

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