Claim-Pro Software

What is Claim-Pro?

Claim-Pro is our software package for TPAs and self funded employers.

Claim-Pro Features Include

  • Claim Processing and Adjudication
    • Can be used to process medical, dental, vision, short term disability, and other types of claims.
    •  Easy to use windows based claim entry and adjudication form.
    •  Tracking of who adjudicated a claim and when.
    •  Ability to do voids, reversals, and corrections in a tractable and accountable way.
    • Ability to print claims received via EDI.
  •  Eligibility
    •  Can view insured statistics such as deductible at any point in time.
    •  Can track other insurance for COB.
    •  Can track changes in names, address, coverage, and other information making it easy to see a history of the changes.
  •  Administration
    •  Companies can have multiple locations.
    •  Companies can be grouped in associations.
    •  Companies can have multiple plans.
  •  Fund and Bank Account Tracking
    •  Can be used to automate reconciling of bank accounts with bank account statements.
    •  Companies can have multiple bank accounts.
  •  Customer Service
    •  Call logging and tracking.
    •  Claim processors can be notified of open issues.
  •  Precertification tracking
    •  Can be entered and then used on claims by the claim processors.
  •  Integrated Claim Image Archiving
    •  Claim images can be tied to claims making it possible to see the image from the claim form with a click of a button.
  •  Plan Building
    •  Ability to add complex plan logic and payment rules.
    •  Can have any number of plan options.
    •  Payment rules can change over time as the plan is changed.
  •  Invoicing o Flexible rate tables or simple fixed rate
    •  Customizable invoice columns.
    •  Can be used to drive automatic payables.
  •  User Menu Administration and Customization
    •  Individual user security and menus.
  •  EDI
    •  EDI claims can be imported directly to the appropriate processor work queue.
    •  Submission of 1099 information to the IRS.
  •  EOB and Check Printing
  •  Provider Maintenance
  •  Reporting Package
    •  Reports can be exported in a number of different formats.
    •  Most reports have an extensive set of criteria that can be used to open the report with only the desired information.
  •  Accessibility
    •  Claim-Pro can be accessed securely over the Internet making it possible for people to work from any location with Internet access.
    •  Claim-Pro looks and feels like it is running directly on your computer while the heavy lifting is done by servers on the backend.
    •  All Claim-Pro Internet access is encrypted to protect data.
  •  Customization
    •  Claim-Pro can be customized as needed.

Claim-Pro Standard Reports Include

  • 1099s
  •  Age Banded Census
  •  Aggregate Attachment Census
  •  Census
  •  Census Summary
  •  Certificate of Coverage
  •  Check Register
  •  Checks
  •  Claim Count by Processor
  •  Claim Lag Time
  •  Claims Paid by Patient
  •  Claims Processed Details
  •  Claim Summary
  •  Claim Turnaround
  •  Company Invoice
  •  Company List
  •  Insured EOBs
  •  Provider EOBs
  •  Insured Cards
  •  And many more reports

For more information Contact Us