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