Membership Management: With Care
Payor you can create a central repository for all member data -
demographics, insurance eligibility, family, medical and other
information. Member data is available through the rest of
the system on a need to know basis to eliminate data redundancy
and improve integrity. Following are some of the other critical
features of membership management:
-
Field
level audit trail is maintained to keep track of changes to
member data
-
Business
rules are date sensitive allowing you to create a strong data
trail to support decisions
-
Ability
to import/synchronize data with other systems
-
Can be setup to allow members
to review and update their profiles on-line
-
Tracking of releases and
consents
Request for Services: Providers in
you network can request for client services through a secure web
portal. Depending on the nature of request, the system
automatically e-mails the concerned department staff. The
request for services module captures all the clinical
information required by your Utilization department to approve
care. Payors can choose from our existing forms library or
customize new forms to capture request for service information.
Authorization management: Care
Payor automates the process of providers requesting
authorizations and your utilization department approving and
sending an approval to the provider - all electronically over
the web. Providers can complete the authorization request along
with the necessary clinical documentation. The UR department is
alerted when new requests are received and can review and
approve the request on-line. Approved requests are available to
the provider through various reports from the Web Connect
portal.
Claims submission: Providers can
enter their claims data directly through the Web Connect portal.
Claims data entry is designed to be easy and does not require
users to understand billing complexities. Various business rules
like authorizations ,provider credentials and service standards
are validated upfront to trap potential problems that would
result in denials. This improves the claims adjudication process
and provider satisfaction.
HIPAA 837 Processing: For providers
who do not wish to submit claims on-line, they can upload files
in HIPAA compliant 837 format format for processing within Care
Payor. Once the file is uploaded, providers can check on the
status of their files on-line. Care Payor has a sophisticated
business logic to validate incoming files for HIPAA compliancy
as well as payor specific business rules. This process
significantly increases the accuracy and reduces the time and
effort required for the claims adjudication process.
Appeals and Denials : Providers can appeal any denials or
claims adjustments directly through web connect eliminating the
need to submit papers.
Outcomes data: Payors can design
and publish various outcome forms to be completed by providers
on-line. This provides an easy and on-going mechanism for
on-going data collection and quality improvement.
Access news updates, training materials
etc.: Payors can use the Web Connect portal to publish
various news and policy updates, publish training materials,
FAQs, conduct surveys and provide other customer service
functions thereby streamlining processes and improving
productivity.
Extensive Forms Library: Care Payor includes an extensive collection of proven electronic
forms to facilitate data collection across all business
processes. In addition to these forms and functions, advanced
users can design new forms using the built in forms designer or
develop complex functions/processes using web technology like
ASP, Java or HTML and integrate them back into Care Payor.
Client Chart: Our unique electronic client chart provides a
single window to review and access all administrative, clinical
and financial client information securely. Information is organized
hierarchically to present data collected under each treatment
episode or an entire episode of care This function is primarily
designed for Case mangers and other payor staff who need quick
access to member information. Access to information is based on
both a form level and record level permission.
Security: Care Payor provides
three layers of security to ensure information is accessed on a
“need to know” basis. Our unique ‘Security Policy’ feature
automatically assigns rights to an member’s records at the
time of data entry. There is also a log to monitor access to
individual records
Claims Processing/Accounts Receivable:
Care Payor also has several provider functions. This is
especially helpful if your organization plays a dual
payor/provider role. Provider functions include the ability to
complete assessments, treatment plans, service reporting and A/R
management. Service reporting automatically generates claims
based on various business rules and allows submission of the
same in HCFA
1500, UB 92, ASC X12 837 and other formats.
Scheduler: The Care Scheduler
features a very familiar and easy to use interface for staff to
manage their schedules. Popular scheduling features include the
ability for users to set their individual work timings, keep
track of no shows/cancellations, search and find openings, print
fee tickets/billing forms and check for credentialing and
authorization information at the time of scheduling new
appointments
Medical Records Management/Barcodes:
Our medical records module integrates with barcode scanners to
provide a fast and accurate way to Check IN/OUT client charts.
You do not have to wonder where a client chart is any longer!
Integration with Signature
Pad: Care Payor integrates with signature pads to
facilitate capture of client signatures for consent forms and
other documentation required by the payor. This is particularly
helpful when the provider conducts the initial assessment.
Reporting and Analysis:
Reporting and analysis functionality of Care Payor is
provided through Crystal Reports – the world’s most popular
report writer. We include over 100 different reports with the
software. Reports that help you analyze member demographics,
provider productivity, claims history, accounts payable,
utilization review, accounts receivables, revenue
statements, payment history and more
