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Claims and Eligibility Management

ProClaims Manager can be implemented on the health plan's, health care provider's, or ISV's  choice of industry standard servers, and deployed to providers in any combination of centrally managed, distributed, and desktop environments. 

Claims Management Solution

describe the imageEDI Connections - Online Claims Management and Eligibility Screening

The ProClaim suite of Electronic Data Interchange (EDI) and integration products enable straight-through connectivity between trading partners and enterprise systems. Built-in ODS and data warehousing provide a solid foundation for information management. Tailored professional services complement these products, delivering solutions that automate real-time exchange for healthcare providers and payers.

Long Term Care Providers use the ProClaim comprehensive user-friendly desktop portal to manage their claims throughout the submission process, with functions for loading, reviewing, and editing claims online. (For example, ProClaim supports importing 270 eligibility requests and 271 responses and matches them for viewing.) Its integrated translation function supports a seamless data exchange with legacy systems, accepting existing print image or structured formats.

 Key benefits of the ProClaim modules include:

  • Quicker claims processing and remittance with real-time editing and a simple, easy-to-use user interface
  • Reduced transaction fees and paper handling costs by enabling direct connection with payers, such as Medicare 
  • Preserving investments in existing systems by offering off-the-shelf claims management applications that easily interface with existing adjudication, financial, and membership systems
  • Limiting financial loss from mishandled payments by enabling better visibility to business systems and transactions through an Operational Data Store (ODS) that can track and link transactions
  • Direct connections with providers, trading partners, and value-added networks
  • Decreased operations costs by automating handling of routine questions and documentation requests associated with eligibility, claims status, and referrals

For more information, call 877-644-2312, or click here to schedule a demonstration of this revolutionary Long Term Care claims management service.