| BPO > Claims Processing |
||
| Claims Processing | ||
|
HTC's Claims Processing and Adjudication Services (C-PAS) includes reliable mail management, claims processing, adjudication, and help desk services for Medicare, medical, dental, and vision claims. HTC processes forms such as health insurance claims forms for professional service (HCFA or CMS1500), Institutional forms (CMS1450, HCFA1450 or UB92), dental, vision, and encounter forms. Mail Management HTC provides a mail reception address and complete mail management services including sorting, logging, and batching of incoming mail into HTC's Workflow Management System (WFMS). This process ensures that all mails received are accounted for. Mails that need to be automatically processed for claims are separated from the mails that require special handing based on customer-defined rules. Claims Processing All forms are scanned, checked for image quality, and transferred using a Virtual Private Network (VPN) or a secure dedicated network to the appropriate production facility. Using HTC's proprietary Data Capture Solution (DCS) all the zones (fields) are electronically identified. Data in each identified zone is recognized using OCR/ICR technology. These field values are checked against a list of validation rules. Fields that do not meet the validation criteria are routed for field correction. Next, a form level validation is performed which includes cross field validation. Any form that fails this validation is manually reviewed for corrective action. The image output format can be TIFF, PNG, JPEG, GIF or any other image format. The data output format can be flat file, CSV, ASCII, EBCDIC, Binary DB specific format, XML, HIPAA 837, NSF or any other customer specified format. Claims Adjudication After the data is uploaded into the customer's adjudication system, the claims are auto adjudicated. The claims can be rejected, paid, or pended. HTC's adjudicators will log into the customer's system and review all pended claims. Based on the business rules of the customer, the claims are adjudicated. This may result in payment to the providers / members and generation of Explanation of Benefits (EOB), or a request for further documentation from the providers / members. 
Click here to enlarge Help Desk HTC's customer service experts are equipped with up-to-date information to manage incoming inquiries from employers, providers, and members. HTC’s customer service experts log into the customer's systems to determine the status of any claim. Value to Insurers C-PAS offers customers the following benefits:
Read More: PDF
|
 |
|||||
|
© 2010 HTC Global Services Privacy Policy | Sitemap