Transaction Processing / Claims Administration

Claims Processing

We handle the claims processing for Traditional & Consumer Driven Health care plans that include HCFAs, UBS, FSA/HSA/HRA/Dependent care Claims forms, Super bills, White bills & Self Paid bills. Currently we are serving for Self-funded TPAs, CDH administrators, Travel & Financial Solution companies and capitation groups across US & Canada.

Current range of services:

• Claims Data Entry
• Claims Repricing
• Provider Matching
• Provider & Facility Database Maintenance
• Enrolment Eligibility
• Benefit Verification
• Claims Adjudication

Process Capability:

• Mail Room Operations
• 1099 Processing Report
• Patient & Provider EOB generation
• Reconciliation
• Customer Support

Enrolments Maintenance

We handle the enrolments maintenance for self funded TPAs. Currently we are handling the employer groups ranging between 20-1200 employees.

Current range of Services:

• Adding the Employee/Dependents
• Changes & Maintenance
• Termination & COBRA
• Obtain COCC & Define Pre-ex
• Determine COB
• Full Time Student (FTS) verification
• Issue ID Cards
• Link PPO
• Issue Correspondence Letters (FTS, COCC, COB)

Process Capability:

• Invoicing