Claims Processing

Claims are adjudicated automatically by our system. Our system performs automated data checks for the following items:

• Eligibility of insured
• Eligibility of charge for covered services
• Eligibility of provider and identification of network providers
• Relationship of charge to R&C geographically specific)
• Satisfaction of deductible and/or stop-loss
• Application of Contractual payment rates
• Application of appropriate co-insurance or incentive co-insurance features
• Application of COB
• Application of subrogation (e.g., workers' compensation, no-fault provision, etc.) where appropriate
• Application of Medicare Documentation
• Application or verification of required pre-certifications.

Our system is capable of identifying and separating into individual data records (by claimant), multiple practitioner visits or facility stays which can been "batched" together by a provider and submitted as a single claim.