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Supports
alternate care delivery systems including Provider/Hospital/Medical
Contracts.
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Assesses
a broad array of covers and benefit options including hospital,
medical, dental, optical, well being therapies and non-PBS pharmaceutical
claims.
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Provides
base system security, which allows Health Funds to control and
limit access to inquiry screens, update functions, databases,
and members’ information.
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Provides
separate screens for registering/login a claim and processing
a claim.
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Automates
eligibility and coverage verification.
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Flags
a warning message when the charge appears to be a duplicate
of a previously submitted claim line.
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Processes
‘per cause’ benefits.
(The system automatically calculates the benefit based
upon the number of occurrences or services.)
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Accepts unlimited
line items and unlimited provider/s on a single claim.
(The system processes an infinite number of claims for
one individual on the same day.)
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Supports multiple
Reasonable and Customary (R&C) tables of charges.
(The system automatically verifies submitted charges
against the R&C tables.)
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Supports and manages
complex benefit tables so claims can automatically be assessed.
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Allows a claim supervisor/auditor
to randomly select claims for auditing.
(The system places the claim on hold until the supervisor
releases it.)
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Eliminates the need
to memorise or look up clumsy codes.
(The system automatically determines the benefits based
upon the procedure code provided on the claim form.)
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Bulk payment processing
provides the ability to combine multiple payments for the same
provider on a single cheque.
This provides savings on postage and supply costs plus
eliminates much of the time spent working with multiple cheques.
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