Claims Management

Claim Management

This system has the capability to track claims by industry-standard codes and procedure codes (lCD-l O-AM, CPT4, etc.) with support of service level processing and an auto coding mechanism. AXIS allows claims to be imported, exported, and replicated incomplete, suspect or fraudulent claims can be flagged for follow-up.

To enhance operations, AXIS it has an automated receipt and numbering procedure for the received claims with the ability to perform batch adjudication and to receive claims electronically. AXIS also detects productivity levels of claims processing per processing agent and keeps track of the processor’s time as expended on each process.

The system automatically identifies claim errors such as missing mandatory data, invalid codes and holds claims that fail any conditions. It always verifies if claims received are from an appointed provider to the client. AXIS determines providers' agreed rates and adjudicates the claim based on the agreed rates.

It automatically detects whether the service was pre-authorized and links claims to related pre-authorizations to apply the proper pricing and adjudication rules. It also analyzes all claims that are received electronically and channels them to the appropriate claim processor for review.

Features Include Electronic & manual claims submission, with support of various formats including XML and .xls Automatic system validations on coverage, limits, deductibles, co-payments, utilization frequencies, etc. Fully customized claim processor queue management based on parameter driven rules Storage of all related claim documents in a digital format Application of all claims restriction rules Support of claims transfer between processors with full process tracking