HBMA FALL 2011
Annual Conference
Bellagio, Las Vegas
Sept 14-16, 2011
www.hbma.org

HFMA's 2011 Annual Conference
Gaylord Palms Resort and Convention
Orlando, Florida
June 26-29, 2011
www.hfma.org

HIMSS Annual Conference 2011
Orlando
Feb 21-24, 2011
www.himss.com

Radiology Summit 2011
Hilton New Orleans Riverside
New Orleans, LA
June 5-8, 2011
www.rbma.org

ASCO Annual Meeting 2011
MCCORMICK PLACE
CHICAGO, ILLINOIS
June 3-7, 2011
www.asco.org

MGMA Annual Conference 2011
3150, Paradise Road
Las Vegas, NV
Oct 23-26, 2011
www.mgma.com
 

 
 

Our Claims Adjudication Expertise includes working with Third-Party Administrators (TPAs) as well as Insurance Payers. We provide the following services:

 

Data Processing:

  •   New Member enrollment
  •   Updating Existing member Records (in case of change in policy and eligibility terms)
  •   Data Capture & other mail room services
  •  Data capture from claim forms (UB92, HCFA 1500) both offline and     online
   
  • Digitization and indexing of any kind of text into digital format
  • Premium Administration
  •  Application of periodic premium received to individual accounts
   
  •  End of day balancing of suspense accounts

Adjudication:

  •   Entitlement:
  • Identification of the patient to determine if the individual is covered by an     active policy
  •   Duplicate Claims:
  •  Verifying to make sure if claim is duplicate
  •   Adjudicate validity of claim/Fraud detection:
  •  Compare HCFA 1500/UB 92 with Medical Remittance Notice and adjudicate if     submitted claim is valid
  •   Validate Claim Amount:
  •  Adjudicate claim amounts considering complex rule sets

 

 

  
 

 

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