Cloud-Based Healthcare Claims
Administration Software Solution

Cloud-Based Healthcare Claims Administration Software Solution

The proposed cloud-based medical claims software is tailored specifically for businesses within the healthcare industry, such as health insurance providers, third-party administrators (TPAs), Carriers, Insurtech, Provider Sponsored Plans, and Medicare Advantage plans. This healthcare claims management software offers comprehensive assessments for clients based on factors such as adjudication, vendor/third-party party needs, and plan offerings. After completing the assessment phase, the internal team moves forward to initiate project planning and work on crafting a tailored, cloud-based solution designed to meet the specific requirements of individual clients. The envisioned medical claim management solution seamlessly integrates with AS400 through the utilization of RPGLE stored procedures.

The healthcare claims management system provides outsourced/backend services such as enrollment services, consolidated billing, benefit loading, and Electronic Data Interchange (EDI) processing. These services help clients reduce time and effort while maintaining optimal efficiency and accuracy in their claims management processes.

USP-FEATURES:-

• Client management
• Enrollment Services
• ID Card Printing
• EDI Processing
• Scanning Healthcare Claims Adjudication
• Benefits input
• Electronic claim submissions
• Claims processing
• Consolidated Billing
• Claim check reconciliation
• Real-time status tracking
• ACH deposits and disbursements
• Prepare various delivery documents like PGS, UTR, etc.