Claims Payment Services

The company delivers advanced technology capabilities to health care payors to enhance the accuracy, effectiveness and efficiency of healthcare claims payment. In bringing insurers, HMOs and other claims payors a service that provides tools and technology for reducing medical costs and administrative expenses, the firm delivers claim and administrative cost savings within weeks, while enabling payors to manage more effectively the workflow and quality of their claim review processes.

Using advanced information technologies, including artificial intelligence and proprietary search technologies, the company helps to:

• detect and prevent a significant percentage of potential overpayments, including those due to duplicate billing, coding errors, unbundling of services and fraud and abuse;
  
• improve claim data quality to increase rates of auto adjudication; and
  
• route claims for focused review when selected patterns of billing or utilization are detected.

Prepayment
The Claims Overpayment Prevention Service enables claims payors to identify potential overpayments before claims are paid. The company detects and corrects a significant percentage of overpayments that are missed by legacy system edits and most software products. For those overpayments that are detected on a pre-payment basis, they demonstrate savings that are immediate, measurable, and have direct impact on the client's bottom-line profitability. The application of client specified patterns and workflow rules allows the company to intelligently review, screen and route claims for focused review and reporting based on any claim attribute, including provider, group, or location.

Application Service Provider
As an Application Service Provider, the firm links clients through a variety of proprietary system integration options. By supporting the content, implementation and maintenance of its applications, this greatly reduces the capital and technology burdens faced by claims payors who want to access sophisticated real-time pattern recognition technologies and knowledge databases. The speed of implementation and flexibility in configuration of the service are important advantages for payors over traditional software approaches.

Client Support
Each client has an assigned team with an Account Executive, Business Project Manager, and a Technical Project Manager. The team manages the implementation and provides ongoing maintenance and support. The company also provides a rich web site for each client and partner, available via Virtual Private Network or secure public Internet with encryption. The web site offers:

• Wizard-style support for the submission and review of claims
  
• Secure file and mail exchange
  
• Access to configuration and rule justification information for various services
  
• Access to a variety of reports and alerts

IntelliClaim, 20 Glover Avenue, P.O. Box 5610, Norwalk, CT 06856. Tel: 203-847-8553; Fax: 203-847-8503.