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PAS
is an end-to-end online, real-time claims processing solution.
Through the use of drug codes, CPT medical procedure codes, ICD-9
or 10 diagnostic codes and ADA dental procedure codes, benefits, plans and
attendant business rules can be defined down to their minutiae—and PAS
will adjudicate online real-time with absolute precision!
Consequently, the advantages of having providers enter claim data
at the point-of-service, coupled with the benefits of online adjudication
and PAS providing all the reporting (including cheque-printing and/or bank
transfers for provider payments), its efficiency and cost-effectiveness
cannot be surpassed.
PAS
allows for an unlimited
Health Insurance portfolio, as well as boundless Provider growth (INTER-
OR EXTRA-REGIONALLY)--all with
a limited increase in fixed costs!!! Upon introduction, PAS
promises a significant decrease in fixed
costs. These reasons alone are enough to justify using PAS as a
claims adjudication solution, but
let’s examine the many other benefits of adopting the PAS approach:
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PAS
removes the burden of manually entering (key punching) claims
(transactions).
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PAS guarantees
the completeness and accuracy of data elements used to process claims.
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PAS
provides greater flexibility in structuring and monitoring benefits,
especially rules governing individual prescription drugs.
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PAS
monitors the use of generic drugs, as well as contracted
individual drug prices between the carrier and any one or
group of pharmacies--and it does so online, real-time!
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PAS allows
for the development of benefits across provider types. Such
benefits can be governed by limits on any combination of period, monetary
maximums, occurrences, per diem maximums, lifetime maximums, etc; thus
resulting in absolute actuarial flexibility in the development of
plans.
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Pro-Analyst
(the carrier's database), facilitates extensive portfolio analysis to
enhance decision-making support and strategic planning.
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PAS
provides real-time information on rejected claims, which can be
accessed immediately through the help desk feature (thus enhancing
customer service), or stored for analysis at a later time. Such
information can be used as a renegotiating tool for extended benefit
packages.
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Earlier
payments to providers will motivate the provider base, yet will not
have the presumed negative effect on cash flow because
point-of-service adjudication can be used to leverage earlier premium
payments.
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The e-mail
facility interwoven into PAS' development not only drastically cuts
carriers' communication costs, it also facilitates automatic
communication with the "prescriber" to authenticate each
claim.
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Because
providers and carriers share the transaction fees, neither has to bare
the full burden of the expenditure.
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PAS is
administered from a Fault Tolerant Service Bureau, and comes with
24-hour a day/7 days per week help
desk support.
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PAS can
adjudicate for foreign carriers (as long as those carriers
conform to Envoy standards).
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The
electronic transmission and receipt of claims adjudication information
between the provider and the carrier will take a maximum of 10
seconds.
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PAS makes it
possible to eliminate or greatly reduce the misuse of health cards.
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PAS produces a multiplicity of reports to enhance management control and
assessment of any or all aspects of the business.
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PAS
facilitates electronic pre-authorizations.
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PAS
maintains subscribers' confidentiality by eliminating the need for
paper forms which can be viewed by several unauthorized individuals.
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PAS
significantly reduces subscriber fraud!
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It is important to point out that PAS is not intended necessarily to replace your present claims processing software, though its benefits are likely to suggest that you do so. If you elect to replace
your present claims processing system, you may do so on your own timetable while PAS continues to work for you, maximizing profitability and enhancing the
management of your business. PAS' EPOS can sit between your claims system and your provider client
base, adjudicating claims and updating ProHealth its claims system online, real-time, and producing a
wealth of reporting . PAS provides for the transfer of transaction updates for your
back-end and for
printing cheques via ProAnalyst and ChequeScribe. By use of IPOS (the internal POS used by the carrier)
the loading of eligibility updates of member and plan data from your claims system is easily accommodated.
Click here
to read two articles written by Douglas Halsall, CEO of AIS.
These articles speak to the state of today's health insurance
industry, and explain in detail how the Provider Access System can
help!
Click here
to view a PowerPoint® presentation on the "Tools and
Rules" of Prohealthi--the adjudication application.
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