Complete Benefits Administration System

PPO and Claims Repricing

Unlimited PPO's per plan.

A single provider may belong to any number of PPO's.

Automatically refers to non-ppo penalty plan when out of network.

Each enrollee may select a PPO.

Accommodates any pricing structure:

	Repricing of claims can be accomplished via in-house system repricing or EDI (Electronic Data Interchange) using a third party clearing house.
	In-house repricing is handled by incorporating rules for repricing into the Complete Benefits Administration System and keeping them updated, thereby allowing the Claims Processing system to re-price the claims as they are entered by the claims processor(s).
	External repricing is handled by sending all claims to an outside repricing via EDI and receiving them back, repriced, ready for the Claims Processing system to complete adjudication for payment(s).