PayerFusion puts the next generation of cost containment and claims management technology at your fingertips
Practical Solutions for Complex Claims Management
The technology and knowledge based enterprises created and employed by PayerFusion represent the next generation of medical claims processing.
Our claims management system facilitates fully integrated transactions between members, health plans, providers and support vendors.
As a result, your cost for services and your cost per claim are drastically reduced. Our clients are provided with exclusive access to a seamless auto adjudication process.
This rules driven process tells you precisely when to touch a claim and when expert intervention is needed. Our dedicated staff offers support for third party adminstrators and are committed to finding the best solutions to your claims administration needs.
We are here to support you throughout the entire claims process.
Policy/Provider Management
- Authorization
- Eligibility Verification
- Treatment Options
- Policy Premium Management
- Member Enrollment (electronic and manual)
- Broker Portal with Commission and Performance Indicators
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Reporting
- Data Analysis
- Plan Modeling and Forecasting
- Benefit and Wellness Reporting
- Region and Industry Benchmarks
- Reinsurance Stop-loss Disclosure
- Benefit Changes Impact Analysis (to employer, member plan)
- Normative and Shock Claim Summary Analysis
- IBNR Reporting Capabilities
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Web-based Support Tools
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MEMBERS
- ID Cards Requests
- Claims Status
- Policy and Benefit Information
- Provider Search
- Provider Quality Outcome Data
- PHR Management
- Payer Communications & Collaboration
- Provider Appointment Scheduling Tools
- Mobile accessibility, Multi-lingual, Multi-currency
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PROVIDERS
- Eligibility Verification
- Claims Status
- Electronic Payment and Remittance
- Real-time Adjudication
- Claim Inquiry to Payer
- Payer Communication and Collaboration
- Mobile Accessibility and Multi-lingual
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Claims Management
- Repricing
- Policy Management
- Electronic Payment and Claims
- Multi-currency Claims Adjudication
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Case Management/Utilization Review
- Episode Life Cycle Management
- Clinical Protocol Management
- Member Communication & Service
- Utilization Management
- Prospective, Retrospective and Concurrent Review
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Network Management
- Private Label Online Provider Search
- PPO Network
- Pharmacy Network
- Dental Network
- Specialty Networks
- National Transplant Network
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