Complete Health Claims Processing, Payment, and Premium Billing Software

Complete Claims Overview

Complete, Powerful, Flexible

Claims Processing and Payment Software Solutions
Adjudication of medical, dental, vision, prescription, short and long term disability claims.
Plan set-up controlled by user.
The Number of plans is unlimited.

Methodology:

Plan or Contract Year structure
Benefit Logic:

Utilizes: CPT's, ICD-9's, DRG's, HCPCS, fee schedules, CRV's and others.

Provider fee schedules
PPO fee schedules and on-line repricing
Complete recall - system can report all changes, how a benefit was paid 5 years ago as well as last month and by whom. Any adjustments are easily tracked, along with what buttons were pushed.
Pre-registration (optional)
Automatic Adjudication (optional)
Capitation processing
Per occurrence tracking
Physician Referral tracking
Coordination of Benefits
Processor alerted to:

Adding new business is simple and cost effective. You can set-up a new plan in less than a day and be paying claims when enrollment is in.
Customer Service may be performed by a processor without interrupting the claim they are working on.
Press a hot key and any existing claimant's or enrollee's records are available, answer the inquiry and hot key back into the claim in process.
Claim can be re-opened at any time for reprocessing up until the check is printed.
EOB's may be printed for any past time frame.
Cash Management:

Bank Reconciliation

Claims Reports

Pre-registered Report - weighted average calculations.
Pre-registered and Claims Pended Report
Enrollment Census report
Processor Summary
Cycle Time Report
Claims Productivity
Claims Count by Date Received
Claims Count by Date
Processed
Claims Awaiting Supervisor and Executive Approval
Pre-certs on File
Claims Detail History Report
Consolidated Paid Claims Analysis
Weekly Income and FICA Withholding
Claimant Benefits Paid Report
Claimant Usage by Benefit Report
Specific Stop-loss Report
Aggregate Stop Loss Report by group and/or location
Utilization Management Report
Total Benefit Analysis
Claims Lag Report
Reports of the TOP Providers, Benefits, Diagnosis Codes, Claimants, Ages, Date ranges, etc.
Provider Summary Report
PPO Savings Report
PPO Withhold Report
COB Savings Report
Hospital/Patient Reports
Monthly check/Deposit Registers by group and/or location.
Exception Reporting for Incorrectly Entered or Incomplete Claims Reports

Any other reports not pre-defined in the system are easily produced in various third party report generators. A data dictionary is available for field definition.

HIPAA

Features

Produces required notification for continuous coverage when a member is terminated and the Group is flagged for HIPAA notification.
HIPAA Privacy Reporting
HIPAA EDI Translator (optional)

Enrollment and Eligibility

Run In

Bringing in new groups is a cinch. Even when you need to accommodate a run in period for the new group.
The Complete Health Benefits Administration System has built-in programs to handle Run-Ins and to bring new business on at a moment's notice.

Enrollment
Flexibility and Simplicity

Employers can enter and update their files at the host location via remote connection(s).
Employees can work from any location.
Information can be received electronically from other sources.
Can receive data from other systems such as a payroll or policy tracker.
Eligibility checking with a single, simple inquiry for providers and employers.

For more information or details about CHS's Complete Claims System, please see our Contact page and contact Sales.

To Download the system requirements information and view offline, simply click the link below. Windows users can unzip these files using WinZip.

Complete Configuration Specs