HSP has built
expert Wizards
into MediTrac™
to simplify, guide
and consistently
handle your members,
providers and
duplicate claims.

Enrollment and Premium Billing

• Fully automates acceptance and management of individual & group enrollment
  • Accepts enrollment in HIPAA-compliant ANSI 837 format
  • Converts enrollment from legacy systems to HIPAA format
  • Handles Medicaid and other enrollment types from third party sources
• Supports Medicaid, Medicare and consumer-driven plan “direct pay” policies
  • Uniquely attaches benefits at the member or subscriber level
  • Bypasses constraints to expedite prospective changes
  • Utilizes scoring logic to accurately apply/manage employer contributions
• Provides mechanism to create fields on the fly and apply/reapply rules
• Efficiently handles individual or global changes (e.g., start/stop coverage)
• Integrates premium billing with accounts receivable

Claims, Referrals and Authorizations

• Leverages efficiencies of Claim Triage™ and UniFlow™ for automated data capture, imaging, cleansing, KFI, loading and routing via intelligent workflow
• Supports user-defined rules to adjudicate, assign actions, perform COB, override claims and make adjustments for expedient claim resolution
• Displays benefit paths and adjudication logic to easily see where and why a claim was stopped for trouble shooting and prompt servicing of customers
• Facilitates timely resolution through automatic routing of claims to work queues
• Complies with HIPAA transaction set formats (ANSI 834, 837, 278, etc.)
• Eliminates need to retrieve original claims via easy image access that includes overlay and magnification capabilities to view images as forms
• Links authorizations to multiple providers for managing episodes of care
• Provides extensive audit trail for analysis and auditing, including HIPAA audits
• Graphically depicts tooth chart and logically applies restrictions to support predetermination of dental claims

Provider Networks

• Emulates physical reality of complex provider relationships (specialties, corporations, vendors) with multiple contracts, fee schedules and pricing methodologies
• Eliminates cost and administrative burden of loading large national networks
• Handles multiple and complex PPO requirements via repricing subsystem
• Efficiently supports exception fee schedule processing, credentialing and directories
• Offers output file for 1099 processing

Benefits and Reporting

• Utilizes service categories to fully automate payment based on procedure and diagnosis, specialty, place of service and modifiers
• Expedites creation of benefit packages using service category groupings and copy/paste; drag/drop capabilities
• Provides optimum flexibility for reporting and output of EOBs, SORs, checks, etc.