Software to Simplify Benefit Administration, Claims Adjudication and Provider Contracting
With the passage of Health Care Reform medical loss ratios are rising, in some cases as high as 85%. As a result health plans must find ways to tighten business processes and control administrative expense. The right software can streamline operational efficiencies, increase employee productivity and reduce costs in health care claims processing.
Our advanced health care claims processing solution HEALTHsuite® Mercato is an enterprise application with fully integrated modules for eligibility / enrollment, benefit administration, provider contracting and reimbursement, utilization management, premium billing, care management, claims processing, subrogation, customer service, fulfillment processing, reporting and more.
HEALTHsuite Mercato is a rules based system with automated workflow capabilities to make health care claims processing both paperless and human-less. Would your organization benefit from auto adjudication rates in excess of 90%? This advanced performance can provide your organization with a unique competitive advantage.