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Claims

Better Claims Processing

Transform your claims operations – in as little as three to six months — with an easily configured, industry leading platform designed to increase efficiency and boost agility. In addition to the platform, Advantasure also provides Claims service with a team of dedicated professionals should you require extra assistance with processing. We deliver:

  • A comprehensive, compliant and low maintenance platform that reduces errors and manual processing
  • Flexibility to select service level and processing needed based on your plan’s operations and objectives
  • A high rate of auto-adjudication through automated administration, thereby increasing payment accuracy
  • Rapid implementation to accelerate cost reductions

Client Performance

  • Nearly 50% reduction in total operating costs, on average
  • Achieved a 95% auto-adjudication rate.

Cost Saving Flexibility

Advantasure’s claims program delivers the cost-savings advantage of supporting your plan’s changing requirements with a standardized solution and platform that provide you with the ability of updating, in-house, existing plans, products and provider entities.

Automation and Efficiency

Our team of experts can manage your entire claims processing function with the same powerful platform. You can:

  • Review and determine claims payment or denial according to CMS rules
  • Develop a claims processing strategy for increased efficiency

Extend Functionality: Add-on Solutions

  • Provider and customer service
  • Correspondence
  • Appeals and Grievances

Additional Features: Simplify Operations and Minimize Costs

  • Establish and maintain benefit categories and plans, payment system rules, and provider contracts
  • Create and maintain facility/professional data within a defined hierarchy that includes network, facility, group or network, clinic or office, and individual physician
  • Administer authorization and referrals against claims, including member and/or providers of the decision (approve, pend, or deny) for each authorization request
  • Accept claims, via EDI or paper, adjudicate them manually or systematically
  • Administer claims reimbursement based on standard or customized reimbursement rules
  • Maintain system codes, including service, diagnostic and internal codes, and benefit categories
  • Generate reports and letters based on processed claims
  • Support delivery excellence in service operations for members and providers

Find Out How We Fuel Accelerated Performance

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