The HC MedNet and ComCare Claims Administration system combine together to present a complete software solution for Providers, PPOs and Payer organizations. Our Internet web site is used by providers to submit claims directly to ComCare. Claims are then paid expeditiously and the information is relayed back to the Provider immediately. With the focus on providing Internet access to the Provider, HC MedNet’s system pushes all claims information back to the source as quickly and as completely as possible. And, by using the Internet to deliver this information and the ANSI X12 EDI transactions to send claims to PPOs and Payers, the software delivers consistent, reliable, and secure results.

Our customers, the people who use ComCare every day, designed the flow of the system. New users can readily follow the logic that was built into it because it is designed to accommodate the way a claims administrator operates.

The Administrative module has a thorough database to administer the plans. Functionality includes enrolling the group and its participants, establishing contracts and plans, billing and collecting premiums, applying payments, paying commissions, issuing certificates/ID cards, and preparing reports on the group or aggregate characteristics.

The Claims module handles all the automated claims processing and reporting activity. This includes checking eligibility, adjudicating claims, and printing the checks and EOBs. This activity is reported back to HC MedNet’s Provider Internet for immediate status updates to the Provider.

HC MedNet’s ComCare provides a powerful product for claims processing that you can tailor to meet the needs of your clients. We offer a claims system that incorporates a full range of automation features for virtually any benefit plan structure. Complex functions are simplified for issuing benefit payments for medical, dental, vision, prescription drugs and short-term disability. Also, to enhance flexibility, functions such as a plan copy, group change, global replacements, and history transfers have been implemented for our clients over the years.

ComCare’s Auto Adjudication system will streamline your claims operation by reducing manual claims processing, thereby ensuring accuracy and consistency based on the tables built prior to processing. Claims can process completely electronically with consistency and accuracy. And, the results are automatically delivered electronically to the Provider, the PPO or the Payer, as appropriate.

With ComCare, the plan design is in your hands. Any new business is readily added without costly system changes. Manage unlimited fee schedules, capitation schedules, individual providers, provider groups, provider networks, management fees, risk pools, etc. Maintain current and historical contract assignments. As imaginative as contracts and plans can get, ComCare is prepared to drive the adjudication effectively.