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CMS1500 Information
Non-Conflict Attestation
Services: |
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A web-based HIPAA compliant application that enables secure data transactions to and from network providers. Features include:
Eligibility Look-Up: Providers may view a member’s eligibility, co-pays, and Primary Care Physician (PCP) assignment. E-Lists are available in a report format, enabling users to sort, analyze and perform capitation reconciliation. Authorization: Allows network providers access to the network, based upon assigned permissions, to submit and look up authorization requests. Requests for services are then submitted through a streamlined interface and may receive an automatic approval based upon predefined, customized business rules. Claims: Look-up, submit, and appeal are the primary features of this tool. Single or batch submission of encounters and claims allow for an instant, user-friendly and HIPAA compliant submission to the Managed Care Organization. Validations, designed in accordance with the client’s business rules, are performed at the point of submission. Corrective feedback is then generated back to the submitting provider, thereby reducing the number of rejected records. Provider Look-Up: View a roster of all participating providers. Information that may be included in the roster is languages, demographics and hospital privileges. This tool enables providers' periodic review of data and the ability to submit updated information requests via the "Contact Us" feature. Forms and Docs: A bulletin board which may be utilized by the Managed Care Organization to post reference forms, provider manuals, and newsletters. In addition, Capitation or Fee-For-Service EOB's may be posted for providers' viewing. |
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