TPA Office Claim Reporting and Recovery
Claim Reporting and Recovery is an administrative application for managing the communication, reporting, and recovery of specific stop-loss claim submissions, receivables, pending claims and denials, and recoveries with carriers.
File specific claim notifications with carriers and MGUs.
- File 50% notifications
- File diagnosis notifications
- Maintain industry and carrier specific trigger diagnosis lists
- Import YTD claim summaries from claim adjudication systems with top diagnosis
- Work notification filing queues and track history
File specific claims with carriers and MGUs.
- File claim submissions
- Work claim filing queues and track history
- Work claim checklist to create complete filing documentation to send to carrier
- Track outstanding claim receivables
- Track pending and denied charges
- File appeals
- Track the final disposition of all claims submissions
- Analyze claim turn-around times and first-time payments
- Track YTD claim charges, diagnosis, claims filed, and stop loss recoverable for all claimants by policy and carrier
- Track claim receivables by filed claim, member, and carrier
- Manage claim receivables with aging reports
- Enter claim receipts and report recoveries to clients
- Track pre-certifications and surgical and outpatient reviews
- Track LCM progress and notes
Assist underwriters with up to date information on ongoing claimants at renewal.
- Provide shock loss claim summary
- Provide claim details on select claimants
- Provide diagnosis summaries ordered by diagnosis with highest dollars spent to lowest
- Provide procedure summaries ordered by most recent date to earliest
- Provide case management history on select claimants