Text Overview
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:
Determine health insurance eligibility.
Adjudicate health insurance claims.
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.
1. 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 PowerPointŪ presentation
on the EPOS.
2. 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.
3. 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.
4. 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.
5. 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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