Complete, Powerful, Flexible
Claims Processing and Payment Software Solutions
Adjudication of medical, dental, vision, prescription, short and long term disability claims. Plan set-up controlled by user.
The Number of plans is unlimited.

• Plan or Contract Year structure
• Benefit Logic:
  • Utilizes: CPT's, ICD-9's, DRG's, HCPCS, fee schedules, CRV's and others.
• Provider fee schedules
• PPO fee schedules and on-line repricing
• Complete recall - system can report all changes, how a benefit was paid 5 years ago as well as last month and by whom. Any adjustments are easily tracked, along with what buttons were pushed.
• Pre-registration (optional)
• Automatic Adjudication (optional)
• Capitation processing
• Per occurrence tracking
• Physician Referral tracking
• Coordination of Benefits
• Processor alerted to:
  • Pre-registrations
  • Pre-certs
  • COB
  • VIP
  • Claimant notes
  • Dependent notes
  • Family notes
  • Provider notes
  • Student status
  • Over % of specific stop-loss
  • COBRA status
• Adding new business is simple and cost effective. You can set-up a new plan in less than a day and be paying claims when enrollment is in.
• Customer Service may be performed by a processor without interrupting the claim they are working on.
• Press a hot key and any existing claimant's or enrollee's records are available, answer the inquiry and hot key back into the claim in process.
• Claim can be re-opened at any time for reprocessing up until the check is printed.
• EOB's may be printed for any past time frame.

Cash Management:

• Micro encoding (MICR) on checks is available as part of the COMPLETE System.
• Logo's and signature's may be scanned in for Laser checks and EOB's
  Bank Reconciliation
• Optional sending of media to bank for reconciliation by the bank
  

Claims Reports

• Pre-registered Report - weighted average calculations.
• Pre-registered and Claims Pended Report
• Enrollment Census report
• Processor Summary
• Cycle Time Report
• Claims Productivity
• Claims Count by Date Received
• Claims Count by Date
• Processed
• Claims Awaiting Supervisor and Executive Approval
• Pre-certs on File
• Claims Detail History Report
• Consolidated Paid Claims Analysis
• Weekly Income and FICA Withholding
• Claimant Benefits Paid Report
• Claimant Usage by Benefit Report
• Specific Stop-loss Report
• Aggregate Stop Loss Report by group and/or location
• Utilization Management Report
• Total Benefit Analysis
• Claims Lag Report
• Reports of the TOP Providers, Benefits, Diagnosis Codes, Claimants, Ages, Date ranges, etc.
• Provider Summary Report
• PPO Savings Report
• PPO Withhold Report
• COB Savings Report
• Hospital/Patient Reports
• Monthly check/Deposit Registers by group and/or location.
• Exception Reporting for Incorrectly Entered or Incomplete Claims Reports

Any other reports not pre-defined in the system are easily produced in various third party report generators. A data dictionary is available for field definition.

HIPAA

Features

• Produces required notification for continuous coverage when a member is terminated and the Group is flagged for HIPAA notification.
• HIPAA Privacy Reporting
• HIPAA EDI Translator (optional)
  
  Run In

• Bringing in new groups is a cinch. Even when you need to accommodate a run in period for the new group.
• The Complete Health Benefits Administration System has built-in programs to handle Run-Ins and to bring new business on at a moment's notice.
  
  Enrollment
  Flexibility and Simplicity

• Employers can enter and update their files at the host location via remote connection(s).
• Employees can work from any location.
• Information can be received electronically from other sources.
• Can receive data from other systems such as a payroll or policy tracker.
• Eligibility checking with a single, simple inquiry for providers and employers.