Security Administration System
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 cycle. Member Enrollment 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... Payments Processing 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. Client Billing 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 commissions. 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. |
