A menu-driven module designed to receive, record, check for eligibility, adjudicate, and initiate payment of all policy claims.
full adjudication on-line for all lines of business
automatic generation of unique claim numbers or manual input
identification of multiple incidents, settlements, benefits, and payments per claim
support and maintenance of appropriate census data as claims are received
dependent / beneficiary information stored by coverage
printing of cheques, EOBs, and provider statements
cheque register for reconciliation
summary of all payments by payee's ID
claims enquiry by group, individual policy, or individual's name at all stages of claim processing
facilities for suspension, reprocessing, cancellation, and special maintenance of all claim settlements
automatic initiation of repeat payments
integration with word processing software and, through activity functions, automatic generation of letters or standard requests appropriate to adjudication
flexible benefits matrix available by plan or linked to coverage
generation of a variety of reports and analyses