Medical / Dental / Vision
Benefits Adjudication Module

Our claims adjudication subsystem is truly impressive! Here is where your staff processes medical cases, and pends/denies/pays submitted claims. Our compacy keystroke design means fewer keystrokes, greater accuracy, and more speed. Bottom line: you save time, money, and errors. Claims can be manually entered for adjudication, entered for re-pricing, or processed using EDI media.

Validations for eligibility and claim duplication stop fund losses. Procedure codes automatically link to the plan benefit code, helping eliminate adjudicator error and also greatly reducing the time require to locate the correct plan benefit code.

 

Our clients have told us that our claims adjudication system can reduce the average training time required to develoop a compentent claim adjudicator from 12 months to about 30 days. All of our clients have eliminated substantial adjudication overtime costs after this systtem was implemented.

Another money-and-time asving feature of our claims payment software is that only one check is issued per provider, accompanied by a list fo claims that are included on the check. This feature can reduce check usage by nearly one third!.

Each subsystem is loaded from the server, making subsystem upgrades centralized and easy. As we upgrade or enhance subsystems, they can be downloaded from our Web site, we can access your server using pcAnywhere remote software, or we can e-mail them to your system administrator. Note how the user can select the group they wish to process. In this example, the menu. This speeds processing and helps eliminate mistakes. This menu tab illustrates the Administration Processing functions, including the general ledger.

 

SBA/i Adjudication Detail Screen

When the inquiry is resolved, the Customer Service subsystem is closed; processing is uninterrupted and returned to the point in the program right where the user previously left off. Our Web-based Customer Inquiry Web site works in a similar fashion. The member or participant logs onto your security-protected Web site and can review their eligibility and submitted claims status. Nightly, weekly, or monthly, an updated Eligibility/Claim Status file is electronically transferred to your site, ensuring timely information availability for your customers.

In addition to the Customer Service subsystem, Premier Data designs interface components for Interactive Voice Response (IVR) systems. The screens and images shown do not constitute the total functionality of this subsystem.

Isn't it time you stopped compromising with your software?
If your software is not fully integrated (Accounting, Cafeteria, Claims, COBRA, Eligibility, Payroll, etc.), then processing in SBA will dramatically improve your accuracy, processing time, confidence in governmental compliance, and overall cost savings. Check for yourself.

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