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Medical Claims Processing Services

Medical Claims Processing Solutions

Third party medical claims processing continues to grow as the healthcare regulations become more complex. A key element to making this process efficient is the ability to classify documents as soon as they arrive at the claims processing facility. The applications, which drive the front end of the claims process, must be able to perform the following activities quickly and efficiently:

  • Provider matching
  • Eligibility matching
  • Automatic CPT, ICD9 code validation with modifiers
  • Custom rule creation across the entire process
  • Manage pharmacy co-pays
  • Automatic identification of exception claims
  • Database cleansing

Our solution was designed by third party administrators, for third party administrators, and provides a number of advantages:

  • Feature rich – We incorporate all of the bulleted features above, providing an application with all the features you need
  • Cloud solution - We eliminate the need for hardware and software capital expenditures
  • Field proven – With over a decade in production, our solution is stable
  • Custom rule creation across the entire process
  • Scalable - Our SQL based platform scales to meet your needs
  • Regular updates - We gather provider and claims data on a nightly basis, providing current provider and claims processing information

The end result is our solution has a faster front-end process, enabling you to process more claims with fewer people.


Contact us to learn more about our third party medical claims solutions