Benefits to Carriers
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 minute 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:
PAS removes the burden of manually entering (key
punching) claims (transactions).
PAS guarantees the completeness and accuracy of
data elements used to process claims.
PAS provides greater flexibility in structuring
and monitoring benefits, especially rules governing
individual prescription drugs.
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!
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.
Pro-Analyst (the carrier's database), facilitates
extensive portfolio analysis to enhance decision-making
support and strategic planning.
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.
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.
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.
Because providers and carriers share the
transaction fees, neither has to bare the full burden of
the expenditure.
PAS is administered from a Fault Tolerant Service
Bureau, and comes with 24-hour a day/7 days per week
help desk support.
PAS can adjudicate for foreign carriers (as long
as those carriers conform to Envoy standards).
The electronic transmission and receipt of claims
adjudication information between the provider and the
carrier will take a maximum of 10 seconds.
PAS makes it possible to eliminate or greatly
reduce the misuse of health cards.
PAS produces a multiplicity of reports to enhance
management control and assessment of any or all aspects
of the business.
PAS facilitates electronic pre-authorizations.
PAS maintains subscribers' confidentiality by
eliminating the need for paper forms which can be viewed
by several unauthorized individuals.
PAS significantly reduces subscriber fraud!
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 PowerPointŪ presentation on the
"Tools and Rules" of Prohealthi--the adjudication
application.
Click on a link
below to read more about the specific benefits of PAS.
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Benefits to Carriers
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