HEALTHsuite®
Claims Administration Module
The HEALTHsuite system includes complete claim support for medical, dental and pharmacy services. Claim dialogs are patterned from the leading industry forms including HCFA/CMS 1500, UB92, ADA, and NCPDP. The Claims Administration module is seamlessly integrated to Benefits, Eligibility, Provider, and Authorization/Utilization Management modules to ensure efficient, accurate claims management.
HEALTHsuite automatically performs claims auditing for fraud detection, duplicate claim checking to prevent double payment, as well as eligibility checking for patient, date of service, place of service, primary care physician, attending physician, diagnoses, procedures, coordination of benefits and third party liability insurance coverage. Additional features include Quality Assurance, user-defined edits, integrated coordination of benefits, overpayment recovery, subrogation, seamless DRG /APC processing, and embedded workflow.