Accounting Integration
Meditrac® HSP Claims Manager provides accounting interfaces to: Microsoft® Great Plains; Intuit, Inc. QuickBooks®; Solomon and Peachstreetaccounting software.
Accumulators and Benefit Management
Benefit use and accumulators are applied based on claim activity; dollars, units, and visits are automatically calculated. Manage deductibles, maximum out-of-pockets, and other limits. View claims and see in detail how each line was applied. Check member and family benefits with a single click.
Auto Adjudication
Auto-adjudication will correctly, completely, and flexibly apply relevant claim review rules and perform additional claim processing functions. HSP's Claim Administration Automation is rapidly deployed to assist in automating adjudication that usually proves difficult to automate. HSP's Meditrac system supports business rules that involve complex reasoning related to any claim, member or provider attribute, and can use large amounts of historical claims data in real time. This ability to reason intelligently across claims using complex business rules and multiple attributes is a key distinction between Meditrac and most other claim editing solutions. In fact with the full native scanning and OCR capabilites many of our customers do not need to manually process most of their claims.
Batch Claim Processing & EDI
Meditrac supports several non-standard and standard batch interface including both the HIPAA 837 and WedMD interfaces.
Benefit Administration
The Benefits Administration module provides cpabilities for your users to manage your benefit plans for HMO, TPA and the new consumer driven models with HRA and FSA accounts. Rules-based benefit logic engine looks at dated pre-certifications and authorizations and matches them to claims along with applicable member co-pays, coinsurance, deductibles, life-time maximums, out-of-pockets, plan year-to-date values, etc. to determine benefit amounts.
Capitation Processing
The HSP Capitation Processing module allows users to create provider capitation payments based on member populations. A variety of population selections and pricing methods are supported, including the standard PMPM and age/sex Schedules and provider specility and demographic schedules.
Case Management
HSP's UniFlow® Case Management module allows case managers and nurses to manage and monitor patient episodes. Cases can be automatically initiated based on authorization or claims activity. Features extensive workflows, the ability add comments, trigger future review dates and events, document archiving automatically integrated authorizations with the claims system. Activities include Large Case Management, Utilization Review, Referrals, and Pre-Certifications or Authorizations. The case management subsystem collects claim and clinical data by episode and tracks the cumulative claim dollars and quantities required in many plan definitions.
Dental & Medical Claims Processing
HSP's unique claims system has set a standard in processing and managing claims. The HSP MediTrac® system delivers functionality, flexibility that most legacy and conventional software lacks. Utilizing the latest technology tools available, HSP MediTrac® delivers a full medical claims processing solution with features to manage membership and claims both efficiently and systematically.
Contract Administration
The HSP Contract Administration allows your users to manage provider contracts as part of the auto-adjudication process. It Supports multiple fee schedules , multiple networks, specialities, PPO network management fees, multiple contract amount calculations, and much more.
Flexible Reporting
HSP is built on Microsoft SQL environment. In addition to being able to report on all the activities in the production system, all types of reports are available through the use of common reporting tools such as Crystal Reports®, Microsoft Access®, Microsoft Word®, and Microsoft Excel®. In addition, HSP provides a total Data Warehouse and Analytical Reporting solution for analytical reporting. The delivery of this capability our claim systems and processing infrastructure already in place is accomplished with relatively little effort on the payor's part. Customers can choose from many pre-canned reports or customize reports to meet their users needs.
Image Archiving, OCR & Retrieval
Image Archiving, OCR & Retrieval easily handles receipt and processing of all medical and dental claim form types, regardless of source: HCFA-1500, UB-92,ADA, proprietary dental form types, Superbills, and claims with attachments. Leverages scanning technology to capture paper claims data, immediately date and time stamp and assign an unique identifier. Replicates EDI ANSI 837 as an easily identifiable HCFA 1500 image. Image immediately builds key indexes to easily locate and assess claims status anytime during the process. Extracts only information that is absolutely necessary to accurately identify the patient and validate his or her record.
Member Services & CRM system
HSP provides extensive support for membership management, full historical eligibility tracking, notes, etc. Uniflow, our CRM (Customer Relationship Management) system tracks call and executes workflows for customer service while at the same time meeting other departmential needs. All claims, authorizations, and other records related to members can be accessed from the Member Services module.
Premium Billing
The HSP Premium Billing module allows users to create invoices for membership enrollment automatically; and manage posting and short-pays. A variety of population selection methods and calculation formulas are supported. In addition, HSP supports several State Medicaid and Federal Medicare eligibility interfaces.
Referrals/Authorizations
Authorizations atomatically interface with UM and your WEB site. Nurses can enter and review authorizations locally or over the WEB when working offsite. In addition, providers can receive authorizations automatically under Payor provider rules and weighted criteria. Claims can then be auto-adjudicated based on pre-existing criteria or routed to claims or UM for special review.
Utilization Management
Utilization Management can enter authorization directly, locally, or over the WEB. Claims and workflows can be autorouted to the UM desk on a case basis. The system has extensive functionality to support internally defined critera, or HSP can integrate with several industry standard Criteria. (ingeix, HSS, M&R, etc.)
Real-Time Interface
A web-based portal exists that allows several real-time transactions to be integrated with your WEB site. This allows the customer to render out their own branding while offering on-line transactions such as Eligibility Inquaries, Claims Submission, Provider Lookups, Claims lookups, etc.
Workflow Management
HSP offers a set of Workflow Tools to insure your professional staff operates efficiently and at the highest possible level of productivity. Features of our Workflow Tools include: Call tracking, FULL CRM capabilities, directing workflow and transactions to appropriate personnel, organizing tasks, prioritizing work by department, facilitate electronic interdepartmental communication, monitors productivity, refreshes work queue; highlights recurring problems, and identifies records that require immediate attention.