Security Administration System
HC MedNet's Security Administration System allows each
Provider, PPO, and Payer organization to manage their own internal
staff’s access to the appropriate features of the HC
MedNet system. To accomplish this, you designate a System
Administrator for your organization. The System Administrator
is authorized to:
- Add new users to the system
- Customize what each user is able to do within the system
- Reset passwords
- Restrict or discontinue user access
- Establish parameters for claims auditing.
With the recent initiation of HIPAA regulations for Privacy
and Security, HC MedNet provides the tools you need to
comply with these regulations through the claims processing life
With implementation of the ANSI standards, HC MedNet's
ComCare product provides the functionality to maintain member
enrollment electronically. This enrollment management tracks member
eligibility, history, provider assignments, and coordination-of-benefits.
This application database feeds the capitation billing process
simply and efficiently.
With the proper access codes, eligibility information can be
directly accessed on the HC MedNet site at any time.
This feature quickly identifies and eliminates eligibility-related
billing issues and delays.
Health Claims Adjudication
ComCare is a fully automated, parameter-driven claims system
that interacts with other HC MedNet modules and features.
The claims module interfaces with the administrative modules to
verify eligibility, Coordination of Benefits (COB), Student Status,
HIPAA transactions, etc. It also interfaces with Provider/Contract
fee schedules and Plan Build tables to identify the appropriate
rates for repricing and/or adjudication.
The Claims Administrative module is also used to control parameters
for auditing and testing the validity of electronic data. Our
clients’ administrators are able to control the values that
determine which claims are held and which claims are released
for automatic payment.
ComCare posts rejected claims to the HC MedNet Provider
Internet where it can be corrected on-line. The correction and
payment process is dramatically expedited through the elimination
of paper claims...
ComCare’s Payments Processing module efficiently batches
claims that have been adjudicated both automatically and after
adjuster review. Electronic notification of payment is returned
to the provider as well as printed Explanations of Benefits and
checks when indicated. Whether a claim is simply repriced and
passed on to a Payer, or is fully adjudicated and paid, this time-critical
information is passed to the HC MedNet Provider Internet
site for immediate notification of payment status.
As with the other features of ComCare, the Client Billing module
provides a flexible, user-driven table to define billing for access
fees, medical, dental, life, AD&D and other charges. Client
bills may be printed with summary and/or detailed member enrollment
that supports the summary charges. The billed charges are updated
to the Accounts Receivable module for applying payments and paying
Adjuster Productivity Management
In order to improve productivity, it must be measured in an accurate,
meaningful way. ComCare’s Productivity Management contains
reporting tools to establish standards for productivity for your
claims adjusters. Volume and accuracy are both measured and reported
by adjuster, group, date and more.
Member Activity History
The member enrollment and activity housed in the ComCare database
is readily accessible through the Member Activity History module.
Many unique and non-unique identifiers can be searched to locate
the records for an individual. Thereafter, easily navigable and
secure screens provide guidance through recorded history. Detailed
requests are tracked to the individual accessing the records and
the reason for access. This information audit is reportable in
full compliance with HIPAA regulations.
This history is also available via our Provider Internet site.
HIPAA guidelines are implemented to display only the allowed information.
Specific and Aggregate Reporting
ComCare has flexible and powerful specific and aggregate reporting
within the core module. The standard reporting tools provide operational
and management reports to measure and control the costs of care.
Furthermore, the database is accessible through user-defined and
ad-hoc reporting tools for the special requests often required
by our clients.