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CAPS/2020 Health Claims Payment Software Ready for new HIPAA Requirements
Issued by: Gregory L. Seelenbinder & Associates
Date: Nov. 5, 2000
|Columbus, OH Gregory L. Seelenbinder and Associates (GLSA), developer of health claims adjudication systems has positioned itself to be ready for the newly released HIPAA regulations regarding the submitting of electonic claims and other administrative health care transactions through the following business partner alliances:
Outsource Advantage of Greenville, SC has interfaced their
E-Net/2020 product with CAPS/2020. E-Net/2020 allows employees and physicians to view eligibility and claims information through the Internet. This product also allows for on-line enrollment.
ABF of Saint Louis, MO has interfaced their Mailroom Outsourcing product with CAPS/2020. ABF uses a data extract module to provide the necessary raw data for processing into mail documents—checks and EOBs. From this raw extract, ABF constructs customized document output, consolidates mail to the same addresses, and uses proprietary mailroom technology to eliminate excess labor, sorting and commingling fees. This saves the typical client over $100,000/year. Finally, ABF dramatically helps the TPA cut costs associated with hard copy print and mail operations resulting in savings of $250,000 or more per year.
As competition drives the ongoing trend towards corporate streamlining, and human resource costs continue to rise, it becomes imperative to employ innovative information technology solutions. With this in mind, GLSA has established an alliance with an IBM Premier Business Partner firm, 3X Corporation of Worthington, OH,
to provide one source for hardware distributions. Being a “Premier” Business Partner, allows 3X Corporation to offer larger hardware and IBM software discounts to their customers than other business partners. 3X Corporation has a staff of ex-IBMers who have marketed the AS/400 line of products since the inception of the product and are all certified IBM AS/400 specialists.
ComCom Systems of Clearwater, FL has developed an imaging system, which will scan documents directly into the CAPS/2020 system. This will dramatically decrease the time spent inputting the mail. Their system will also allow for Internet access to scanned documents.
Extol of Franklin Lakes, NJ uses their EDI Integrator package to pass information electronically into the CAPS/2020 system. Their package allows for the mapping of all ANSI and proprietary information coming in from clients all around the world.
Ingenix of Salt Lake City, UT has various Usual, Customary and Reasonable (UCR) Fee schedules that enable the CAPS/2020 system to automatically reduce payments. They also have authored the Claims Edit System (CES), which prevents inappropriate billing practices, such as unbundling, missed multiple frequency discounts, billing for follow up days, etc. CAPS/2020 will process claims against the CES system sending all errors to an examiner for further review. Claims that are clean can be sent for automatic payment without any further human intervention.
COB Clearinghouse of Broadview Heights, OH has integrated their proprietary COB system with CAPS/2020 to conduct a comprehensive COB test against the official records of eligibility of a large number of insurance companies. Clients using their service can expect a recovery of claims expenses by finding occasions where their plans were secondary to another insurer.
Ohio Data Transfer of Columbus, OH has integrated their Voice Response and Fax Units with CAPS/2020. Now an employee or provider can inquire 24 hours a day regarding employee eligibility or the status of a claim.
These new business partner relationships position the CAPS/2020 system for the “paperless” 21st Century. Using the above outlined features allows only “problem” claims to be reviewed; all other claims can pass directly from the electronic input stage to the electronic output stage without human intervention or the generation of printed documents.
All of these business partners were present at our last CAPS/2020 user conference held in Scottsdale, AZ. The theme for the conference was: “Time’s Running Out!” In order to stay competitive in the 21st century, organizations and TPAs must streamline their businesses to become less labor dependent through the use of the automation techniques available through CAPS/2020.
For more information, please visit the CAPS/2020 web site at CAPS2020.com or contact us at: GLSA, 3482 Trenton Road, Columbus, OH 43232, phone 614-833-6952, fax 614-834-0972, e-mail firstname.lastname@example.org
For more information: http://www.caps2020.com
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