Health Benefit and Managed Care Solutions
What will HEALTHpac do for You?
HEALTHpac, a comprehensive health benefits management system, is the central hub of a suite of fully integrated software products and ASP services. Their purpose: to deliver increased efficiency and profitability. As Eldorado’s flagship product, HEALTHpac has been subject to over 15 years of continuous development in response to client requests and industry evolution. Features include:
- Claims Input via EDI, Scanning and Manual Entry
- Medical, Dental, Vision, Rx and Disability Claims Management
- Advanced Dental Logic (Tooth Chart, Surface and Service Tracking)
- Multi-option "Coordination of Benefits" Processing
- Aggregate and Specific Tracking
- Contract Management
- Fund Accounting
- COBRA
- Section 125 Flexible Benefits
- Automated Workflow (See our Workflow with Imaging overview)
- Auto-adjudication
Healthpac's Integrated Managed Care Features Include:
- PPO Repricing of Professional and Facility Claims
- Automatic Adjudication
- Patient Encounter Tracking
- Capitation Processing
- Integrated Case Management
- Output Routing System
- Call Tracking Subsystem
- Basic Reimbursement Schedules
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- Insurer, Government, Employer Contracts
- Complete PCP/Referral Processing
- Per Diem Rates, Per Hour Rates, Percent-Off
- Maternity Packages
- Surcharges, Thresholds, and DRGs
- Global Fees
- Fee for Service
- ICD-9, CPT-4, HCPCS Codes and others
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HEALTHpac's powerful calculation logic determines the allowable reimbursement of a claim within the context of an "episode of care." It identifies episodes by examining indicators:
- Interim Bill
- Certificate Number
- Procedure Codes
- Patient Control Numbers
- From and Through Dates
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- Provider Specialty
- Procedure Code Ranges
- Diagnosis Code Ranges
- HCPCS Code Ranges
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HEALTHpac Calculates Contract Allowables Based on:
- Per Case
- Per Diems by Date of Service
- Stop-Loss Provisions
- CPT-4 and ICD-9 Level Exceptions
- A Specific Contract by Important Contractual Clauses (such as Service, Diagnosis, Place of Service, Procedure)
- Number of Visits
- Percent of Charges
- Volume Discounts
- Results of Cumulative Contract Payments
Stop Costly Overpayments with HEALTHpac and Ingenix®
Detect and correct medical cost overpayments due to upcoding of claims. With the help of Ingenix' databases, HEALTHpac identifies inappropriately coded surgical, laboratory, radiology and medical procedures. If you wish, it will automatically correct the errors by group.
Ensure Appropriate Payments for Virtually Any Fee Schedule
HEALTHpac support virtually any usual, customary and reasonable (UCR) pricing database. Examples include Ingenix' medical, dental, anesthesia and HCPCS modules; PHCS/HIAA, RBRVS, ADP; as well as specific user-created fee schedules.
Communicate Easily Via a Built-in Correspondence Manager
HEALTHpac's letter generation utility makes it easy to communicate with eligible employees and care providers. Create ad hoc letters, letters requesting additional information or medical reports, and denial letters. Generate them on-the-fly or automate the process. Plus, there is a complete online, viewable history of all eligible employees' correspondence.
HEALTHpac Speaks EDI (Incoming-Outgoing)
Claims may be received electronically, scanned using OCR technology, or input manually from facsimile or hard copy HCFA 1500 and UB-92 claim forms.
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Call Eldorado today at (602) 604-3100 to arrange a demonstration of HEALTHpac and learn more about Eldorado's other managed care and health benefit management solutions. |
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