Claim Processing Experts

Claim Processing Experts | PPO contracts | Health benefits administration | Electronic Data Interchange

HEALTH CLAIM PROCESSING EXPERTS

Our team has wide experience with all types, formats and complications found in health claims.

EXPERIENCE

Here are just some of the health claim related topics that we see regularly:

  • Professional, Facility, Dental, Pharmacy, Vision, Short Term Disability, Life
  • Electronic Data Interchange
  • Real-time Claim Processing
  • Duplicate detection
  • Coordination of Benefits
  • Medicare Pricing and Edits
  • Bundling/Unbundling
  • Clinical Edits
  • Anesthesia
  • Durable Medical Equipment
  • Usual and Customary
  • PPO Re-Pricing and Contract Management
  • Benefit Plan Adjudication
  • Integrated Health Savings Accounts/Health Retirement Accounts
  • Reinsurance Contracts
  • Interim Claims
  • Claim Payment, Explanation of Benefits, Explanation of Payments
  • State based Prompt Payment Rules
  • Mom/Baby Maternity Claims
  • Capitated Services
  • Claim Routing
  • Authorizations, Referrals, Case Management
  • Subrogation
  • Grievance and Appeals
  • Out of Network Negotiated Claims
  • Non-Traditional Service claims