Administrative Module

 

Payment process

Analyzes and processes capitation, incentives and fixed payments to your medical group providers.

Claims processing

Analyzes, audits, validates and pays claims fee for services (FFS’s); creates fee schedules for each provider and specialist and creates limits for service, age, sex and quantity.

Checks

Creates and prints checks in batches for all payments an invoices by other medical group vendor.

Claims reconciliations

Analyzes and reconciles claims paid by the insurance carriers and credited to your medical group.

Debits

Creates account payable from provider’s financial transactions, such as advances, etc., and set up amount and instalments to be deduced from future payments.

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Encounter Submissions | Clearinghouse

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​For processing encounters, we offer a tool that is centralized, automatic and ansi 5010 medical group compliant. The system allows the provider to directly enter encounters at a central level and submit them overnight to the carrier.

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Smart Cube [ad-hoc] | Analytics Reports

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​Has the tools that allow users to design, organize and calculate all desired industry reports-especially useful for those who prefer “ad-hoc” reports and are more proficient with this type of data mining tool.

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Utilization Profile Reports

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​All reports are branched in hierarchical order, where the administrator can assign security permits to each report.

 

Sample reports include:

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•  Eligibility

•  Financial Report

•  Top Utilization Report

•  Claims Drill Down

•  Peers Comparison

•  Institutional Metrics

•  Trend Analysis

•  Dashboards

•  Claims Auditing

•  Disease Management

•  Encounters

•  Quality Metrics

•  Member Profiles

•  PCP log

•  Preferred Provided Network

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Five Star | Prevention Module

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​HEDIS Five star is a prevention module that provides both the medical group and supplier the information and metrics needed.

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SmartCap | EHR | HUB Integration

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​SmartCap®, HER and HUB integrate using historical and real time clinical aggregated data to maintain the functionality of three important point of service components:

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•  Patient Profile: provides a view of all Clinical Data concerning the patient.

•  Prevention Dashboard: offers all HEDIS metrics and Five Star scoring.

•  Utilization Profile: provides historic financial data of members.