CLAIMSplus

Managing your Client Claims

Expedited claims.  Multiple interfaces sync with your corporate brand. Digitized data environment that can be accessed from anywhere, at any time.  Health and Life processing via faster systems that aligns with your processing needs.

Speeding up the claims life cycle to match the influx of your claims—while reconciling and resolving the more complicated claims at record velocity.

It’s in. It’s out. No interruptions or claims processing delays.  CLAIMSplus moves claims faster, working with employers, TPAs and insurers with robust in-the-cloud processing platforms.

CLAIMSplusis in the business of optimizing processes and expediting medical claims through secure, reliable and efficient electronic claims management.

Faster Inputs Mean Speedier Outputs

claims payment cycle time problems and how our system help in reducing.
Claim Requisition

Claim Requisition

Claim Review

Claim Review

Claim Estimation

Claim Estimation

Claim Processing

Claim Processing

Claim Settlement/Payment

Claim Settlement/Payment

CLAIMSplus gives you the choice

We empower our customers.

More to the point, our technology—first and foremost—manages claims quickly and efficiently.  We’ve asked our clients, and the timescale of the claim is the most important element for claims processing. For this, a single platform seamlessly feeds into client and provider systems. This translates into claims processing triaging that gets it right each and every time. By using a single platform, CLAIMSplus provides distinctive claim strategies for our individual clients since no two insurers are the same. We layer new technologies alongside claim automation.  Among so many other benefits, by enlisting our claims processing services, CLAIMSplus permits payers to release on-site skilled claims professionals to work on less time-consuming activities. CLAIMSplus technologies overlay new datasets with claims data, thereby offering a wide array of claims solutions and approaches.  We select what works best for each of our clients, no matter their company sizes. Our cloud integration platform enhances connections between on-site and cloud environments, with interfacing applications that yield platform connectivity and compatibility with other systems.

CLAIMSplus Advantages

  • Expedited claims processing systems that cut down on claims administrators’ manual efforts.
  • Scalable networks that increase claims’ processing throughput, all the while placing you and your business on a robust path for growth.
  • A strong data analytics platform that supports data-intensive applications for real-time analyses, reviews and reports.
  • Fast claims eligibility processes through automated user tools including auto-calculate that propels processes and drives claim efficiencies.
  • Data connectivity that produces automated emails, letters, and all related claims correspondence.
  • Agile alignment of disability and leave claim information, including time used as well as time left.
  • Enhanced processing accuracies due to split-second data scrubbing—cutting claims rejections way down!
  • Secure platform compatibility via complete processing integration for employee Disability and Absence claims.
  • Customized claims solutions engineered to expedite payments that are on time and on point.
  • FMLA and ADA claims sorting and processing that eliminates claims’ redundancy and inaccuracies.
  • Network-attached data storage (NAS) that combines distributed computing with sound claims processing software.
  • Staying put within one system as opposed to changing over between incompatible claims processing programs.
CLAIMSplus ensures excellence by enlisting our expansive software compatibilities and capabilities that align with medical insurance payment systems along with negating redundancies that slow payments down. Our robust electronic claims administration systems are tried and true, giving our clients the type of transparency and affordability that accelerate payments and get claims approved faster. Partnering with industry-leading Third-Party Administrators, insurance providers, employers and the like, CLAIMSplus reconciles billing discrepancies through automated adjudications that surpass industry norms, all the while boosting processes and healthcare payments that not only pay off—but pay fast.   Our comprehensive core claims administration solution is utilized by healthcare payers and TPAs who are serious about offering best-in-class advantages. The automated electronic tools developed by CLAIMSplus are designed to speed complicated healthcare claims. Enterprise workflows are easily consolidated as are document-management processes that integrate and optimize claims administration at every level. Our robust platforms support medical, vision, dental and specialty health benefits administration for big hitters in the industry including Medicaid, Medicare Advantage, and the commercial industry with uber-intuitive processing systems. Capturing cost savings with compatible claims systems is just one common goal. Outcomes from these programs will vary by administrator or TPA, but they can result in decreased durations, increased RTW rates, and fewer manual hours necessary to manage these programs. By taking a trusted and data-centric approach to RTW, TPAs can realize anywhere between 40-to-50 percent direct program savings.  WC and Disability claims processing are streamlined with CLAIMSplus. By reporting multiple claims through a single intake process, redundant acitivites and associated manual costs are eliminated.

We don’t pitch you the extras if you don’t need them.

CLAIMSplus does not simply tell you every last detail—unless you want us to.  We listen and read between the lines—offering expert and powerful claims administration solutions that are wisely suited to your level of growth by way ofour payer platforms and customized billing software.  

We keep your best solutions top of mind and on point.

CLAIMSplus customizesservice options while providing Best Practices in claims administration for companies of all sizes. Give us a try for free!

A rejected claim may be caused by a clerical error, or it may come down to inaccurate procedure and ICD codes. CLAIMSplus avoids rejected claims by scrubbing, resulting in a clean claim. Time-consuming and costly resubmissions and appeals are pure headaches, so CLAIMSplus gets it right the first time by automated system alerts, thus pushing aside –literally—incompatible procedure codes and visit claims and replacing them with the right data that aligns with patient coverages.

42% of claim denial write-offs are the result of human error.

With CLAIMSplus, our clients realize cohesive upstream and downstream activities. TPAs can create customized reports for employers and run ad-hoc data reports without enlisting dedicated resources for building custom queries. By selecting a cohort and clicking a button, reports can be generated immediately and with ease.
CLAIMSplus also connects victim compensation claims to the New Jersey Victims of Crime Compensation Office (NJVCCO) via our partnership with them. Our systems are fully capable of these types of claims for those who deserve reimbursement for their medical care associated with crimes they’ve endured.
CLAIMSplus: Accelerating Payment Processes with Automated Approval Tools

What can CLAIMSplus do for you?

  • Deliver robust claims management solutions
  • Automate employee benefit plans
  • Verify benefits’ offerings
  • Customizeautomated systems for Healthcare Payer and TPAclaims
  • Eliminate duplicate billing
  • Auto-flag inaccurate medical codes, or lack thereof
  • Process and reimburse NJVCCO claims
  • Tailor data analytics reporting
  • Strictly adhere to filing deadlines
  • Comply with HIPAA regulations and PID standards
CLAIMSplus easily detects fraud, waste and abuse (FWA) via electronic claim-editing tools.  We can oversee any capitation contracts as well as provider capitation arrangements. Our exceptionalclaims processing system includes retroactive adjustments and multiple premium rate structures.  CLAIMSplus can support multiple reimbursement arrangements for enhanced network management leaving you time to cultivate even better collaboration with providers and members.

Modernizing your technology means upgrading to CLAIMSplus.

TPAs and Healthcare Payers realize greater return on investment by enlisting our modern core claims processing system as their go-to technology foundation. A scalable and flexible payer platform, CLAIMSplus takes into account your current operational and technical needs.  By this we don’t mean one size fits all.  We understand that you may need support for multiple lines of business, but that each business is unique.  Each client is distinctive.

Our next SOLUTION could be yours.

  • Look to CLAIMSplus for:
    • Customized solutions including ala carte options
    • Technology that fully encompasses industry standards
    • Real-time data transaction management
    • Payment acceptance in the methods your clients prefer
    • Expedited claims processing methodologies
    • Superior auto-adjudication tools
    • Accurate payment rates
    • Provider services and membership billing
CLAIMSplus offers a fully integrated financial, operational and essential channel payer system that includes an open—yet fully secure system with web services that automate healthcare regulations—new and existing— along with other claims processing requirements.  Other CLAIMSplus processing features include:
  • A core administrative system
  • A single-source database
  • Interactive web portals and intuitive dashboards
Our system has been programmed with sophisticated logic to ensure that all data is scrubbed clean for accuracy. We do this ahead of implementing our CLAIMSplus solution or a re-pricing engine.

CLAIMSplus CYBERSECURITY

We fully realize the treacherous environment for which we live, and it’s never been more important to protect mission-critical data such as personal information and healthcare-related electronic data.  CLAIMSplus leverages powerful preventative measures in order to protect sensitive information from being stolen, compromised, or hacked. Our programmers and systems analysts understand the seriousness of potential cyberattacks as well as viruses and other malicious code. CLAIMSplus enlists resilient cyber-protection strategies such as risk management, identity management and incident management, to name a few. In addition, we incorporate the following measures in order to safeguard your precious data from detrimentalattacks:

  • Continuous antivirus software updates
  • Strong passwords with frequent and required changes
  • Designated andlimited privileged users via access control
  • Implementation of, and compliance with best data backup and protection techniques
  • Never disclosing personal information

We understand that cost containment in claims processing administration is, well, everything.

 

Managing costs is paramount. Healthcare payers and third-party administrators don’t want to bust anyone’s budget any more than do we. CLAIMSplus delivers robust and strategic claims processing models that rein in costs and save operational dollars. Our reimbursement configurations and automated late-payment fees drive everyone’s costs down. Automated repricing tools and other advanced algorithms work to reduce claims processing costs with overarching outcomes you will only experience by partnering with CLAIMSplus.

Smart Business Intelligence (BI) translates into smarter processing so payers can recover significant savings. Formidable benefit calculations are automated with such regularity thatwe may even make it look easy. Complete with automated audits, real-time built-in alerts, membership and eligibility management tools, CLAIMSplus saves our clients’ budgets in a variety of ways.

Auto-adjudication and accurate coding tools help you contain costs with affordable and intuitive administrative processing technologies that meet most budgets. Rules-based configurations are electronically automated, including late payments as well as interest calculations. Customized EOB codes allowsuch actions as deny, pend and approve. With CLAIMSplus, we can auto-generate AR and AP transactions,thus yielding additional ways to save operational and claims management costs.

CLAIMSplus: Reducing Redundancy & Realigning Your ROI

CLAIMSplus Clients are:
  • Third-party administrators
  • Preferred Provider Organizations (PPOs)
  • Accountable Care Organizations (ACOs)
  • Self-funded Organizations
  • Insurers
  • Capitated Payors
  • Prison Health Systems
  • Any entity that handles claims, enrollment, etc.

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