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| Claim
System Summary |
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| Claims
administration in a powerful data management and reporting
environment |
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Increasing
demands are being made to bring health care costs under
control. The
Paragon21 Claims modules:
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Reduces
administration costs;
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Promotes
cost containment efforts;
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Promotes
utilisation review efforts; and
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Provides
meaningful statistical information for analysis. |
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The
Paragon21 Claims Modules automates virtually every claims assessment,
administration, and reporting activity.
The system’s comprehensive components manage:
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Rules/benefits/limits
and conditions.
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Hospital
and Medical Contracts.
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Per
case, calendar year/s, policy year, or rolling benefits periods.
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Casemix
and episodic claims (tracking episodes and events).
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Provider
arrangements/contracts.
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Dental
cover.
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Optical
cover.
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Well
being therapies cover.
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Health
Management services.
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Medical
services.
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Pharmaceutical
(non-PBS).
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Hospital
Cover.
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Ambulance
Cover.
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Any
other type of Cover.
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| Paragon21 Claims Modules provides…
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Greater efficiencies in claim processing through:
1) Reduction of internal administrative costs.
2) Accommodation and automation of unique assessing procedures previously managed manually.
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Greater productivity through:
1) Reduced assessors clerical tasks.
2) Increased assessors output.
3) Increased assessors efficiency and consistency.
4) User documentation and Courseware containing step-by-step instructions for using the system.
5) On-line help screens with natural language interface (for questions and answers) that reduces research time.
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Cost analysis and cost containment through:
1) Useful information collection, maintenance, and reporting features.
2) Audit facilities.
3) Claim editing/validation.
4) Auto generated and stored correspondence.
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Lower Data Processing Costs through:
1) Scalable design.
2) Member specific user exits/parameters.
3) Utilisation of a relational database.
4) Screen driven operations and reporting functions.
5) Six monthly updated system releases, which provide base system enhancements and respond to legislative and technical changes.
6) Knowledgeable product support and state of the art systems from The Paragon21Team staff.
7) Complete history including all correspondence available on-line.
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Paragon21 Claims Modules perform real-time, on-line claims assessment and administration. The system retains comprehensive historical claim data on-line. It is the most effective claims control tool, available for cost containment reporting and analysis.
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Using the Paragon21 Claims Modules, you can offer maximum flexibility, whether your Fund has 100 members or 100,000. Paragon21 Claims Modules also provide you with access to a wealth of statistical information for monitoring and reporting purposes.
The Paragon21Team staff understand the claims administration business. We know how important it is to have a reliable and efficient claims administration system to handle the business for today and tomorrow.
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