Adjudication, Administration & Reporting,

All In One Fully-Integrated Environment

Real-Time Rules-Based

Adjudication Environment, Unique In The Industry

Our real-time, “rules-based adjudication” environment is unique in the industry, providing a sophisticated and highly competitive solutions to the marketplace, both in Canada and globally. We can administer, adjudicate and report for all benefit types in one fully integrated environment. Features include:

  • Drug, Dental, Medical, Travel  and Disability Claims Management, all in one environment.
  • The instant creation of procedure codes and fee guides, even for plans not currently administered.
  • Client management, plan set-up and maintenance.
  • A full suite of procedure codes for all major adjudication types, as well as various customizable fee guides that govern pricing.
  • The ability to adjudicate claims that involve coordination of benefits, company couples, twins, and coordination between various plans (cost plus, HSA, insured).
  • Automated claim adjudication routing (Plan vs Cost Plus vs HSA), right down to the procedure code.
  • Negative payment tracking with provider/member separation to avoid the potential for an overpayment during the claim reversal process.
  • A fully-integrated, customizable rules engine that allows any user to create specific rules - from the group level to the recipient level - within minutes.
  • A full rule and benefit plan library to allow for quick, simple plan creation. If we don’t have the plan or rule, we will create it within minutes.
  • Cost containment using separate adjudication for ingredient costs and dispensing fees by utilizing pre-defined maximums that recognize regional differences.

Let us know how we can help.