Medical Claims Software

A1 Enterprise is moving into the next phase of a new medical claims software implementation for a key international customer. Features will support online medical claim forms, claim approval workflow, history logs, file attachments, and validation against an existing medical insurance policy. Claim expenses and reimbursement requests will integrate into an ERP accounting system and synchronize into the A/R & A/P modules for cutting checks and the accounting GL. Medical Claims Software

The highlight of this system will be a unique, slick, and highly intelligent online medical claim form that extends the process of claim submission to claimants and their dependents, where previously they were required to work through their medical providers, doctors, and hospitals for claim submissions. When a claimant submits an online medical claim form administrative users will be notified and key claim reviewers will be requested to process the claim by accepting or denying the claim and requesting more information. Claim RFI letters may be sent directly from the system from claim reviewers if more information is required from the claimant. Document attachments such as medical bills and diagnosis sheets may also be uploaded by claimants for supporting information.

An online claimant portal will be provided where claimants can login and view past or pending claims and their status. With a robust user security module, administrators will have options for allowing managers of various medical clinics and hospitals to view claims submitted for their institution, to verify against local medical records. There will also be an insurance underwriting process that ties into the medical claim submission process that imposes limits on who can submit medical claims and for various benefit types and benefit amounts. The medical claim software reporting system gives claims managers and executive officers highly flexible reporting tools for creating custom reports and saving for future use or sharing them with other users. Additionally this deployment will support IT administrators ability to create their own custom reports and report formats using internal reporting engines.

The system will be deployed on-site hosted by a key customer’s data center to ensure full data security and local compliance with data privacy regulations. This deployment includes the migration of existing claim and insurance data from a legacy DOS-based system that has run the company for decades.