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Advanced Integrated Systems (AIS) is proud to
introduce the Provider Access System:
the world’s first and only complete online,
real-time health claims adjudication system. It is designed to give
healthcare providers access to immediate and updated insurance information
for patients and customers. You
will find that the Provider Access System (PAS) is uniquely able to
increase intra- and interoffice efficiency by decreasing the amount of
time needed to:
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Determine health insurance eligibility.
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Adjudicate health insurance claims.
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Retrieve a considerable amount of additional
patient/customer information.
Furthermore, PAS will facilitate the timely receipt
of reimbursement cheques and perform a host of other timesaving functions.
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EPOS is the External Point of
Service
application that is installed in healthcare professionals'
(Providers') offices. EPOS is currently installed in hospitals,
pharmacies and laboratories, as well as at medical,
dental and optical Provider sites throughout Jamaica.
This software allows users to swipe patients' electronic insurance
cards and enter procedural, diagnostic, pharmaceutical and pricing
information. Once this information is entered into the system,
patients' status with an insurance company can be queried (called an
Eligibility Check). Eligibility Checks allow PAS users to
confirm patients' eligibility to receive particular services, and
apprise Providers of how much an insurance company will pay for
each service rendered. Once the optional Eligibility Check has been
performed, health insurance claims can be officially submitted to the
insurance company. Both Eligibility Checks and Claims
Submissions take place over a modem via a dial-up connection initiated
by the Provider's computer. Click here
to view a PowerPoint® presentation on the EPOS.
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IPOS is the Internal Point
of Service application. It is a derivative of EPOS, and is
used by the insurance carrier to submit paper claims to PAS for
processing.
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IVR is the Interactive Voice
Response System, which can be used by Providers in the
event that their EPOS terminal is not working (due to power failure,
etc). A provider simply calls an automated (and interactive)
system, which requires that certain identification information be
entered via a touchtone telephone. One the caller's identity has been verified, the Provider can get provisional
authorization for a claim. In such instances, the funds are escrowed,
and will be released to the Provider when the carrier receives a paper
claim. Note that subscribers can use the IVR to check their card
balances.
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PHi (ProHealthi) is the
database which contains a carrier's business rules, policy
details and payment information. It is this database that
providers' computers connect to when they are using PAS to adjudicate
claims. Click here for more information on ProHealthi--the
adjudication application.
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PAS As A Total Solution: All of this
is facilitated by a one-of-a kind, first in the world, online
real-time claims processing application that for all its
sophistication, is intuitive and permits Carriers to easily set
up all of their plans and associated eligibility rules in an Oracle
database. Industry standard codes such as ICD 9/10, CPT, ADA and drug
codes are used as building blocks, along with editing tools such as:
quantity over time, benefit and plan maximums, exception lists,
number of occurrences, UCRs, etc., to define benefits down to their
minutiae. PAS will adjudicate any claim--base or major
medical--within 10 seconds and provide both the Carrier and the
Provider with the finest audit trail for easy reconciliation.
Redundancy is a hallmark of PAS' design, and "simplicity"
is a word that our users frequently associate with the Provider
Access System. Since its network is based on IP/VPN, we have
introduced e-mail to facilitate Carrier-to-Provider and
Provider-to-Provider communication. This has enhanced communication
tremendously whilst reducing paper and allied costs to their barest
minimum.
PAS generates and maintains over 100 data elements on each claim.
This facilitates the most profound analyses and can be maintained
for as long as the Carrier wishes. With all of this, PAS cannot be
beaten in its consideration and provision for redundancy. Even
"Acts of God" are considered. PAS is indeed a total
solution!
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