Claims Administration

Claims Administration

Beacon Health Solutions offers flexible, cloud-based claims processing and adjudication solutions for commercial, Medicare and Medicaid markets that reduce the cost of technology ownership and allows for rapid implementations. Through the use of our claims systems, our clients achieve greater levels of operational efficiency.

On average we process 98.5% of claims within 30 days with financial accuracy at 99% and statistical accuracy at 100%.

Claims can be received in multiple formats. Paper claims can be accepted via hard copy or fax or electronically syncing directly to the claims system. In addition, our determinate engine, a user-configurable feature, allows the user to specify parameters or rules to accurately process, pay and store claims and claim payment remittance advice/EOPs/EOBs according to CMS processing guidelines and payment methodology as well as the individual health plans rules.

We provide claims management solutions to help you achieve your business goals.

  • Improve the accuracy of claims adjudication
  • Drive high auto-adjudication rates and lower cost of administration
  • Integrate claims edit and re-bundling
  • Conduct complex benefit and reimbursement methodologies
  • Complete HIPPA compliant transactions
  • Increase paperless workflows
  • Lower administrative costs to better meet medical loss ratio and other regulatory requirements

As an established leader in the healthcare industry, we deploy the software solutions that work and deliver the capabilities to achieve your highest business goals.