Third-Party Administrators

Managing a TPAs claims flow is like herding cats. Multiple regional and national health networks, Physicians, Hospitals, PPOs, Repricers, discount negotiators, Out of Network repricers, clearing houses, paper to EDI services are just some of the other entities that get involved with TPAs in processing medical claims. The more unified and seamless the solution that connects all these participants the more efficient and cost effective a TPA will be to its customers (payers, subscribers and employers). ClaimsBridge gives TPAs this capability.

ClaimsBridge is a combination of software and services implemented on the Internet Backbone that will facilitate the electronic transmission of medical claims from Provider through the multiple pathways necessary to deliver a clean claim ready for auto-adjudication by the TPA. ClaimsBridge boosts the TPAs auto-adjudication process by extending the power of the TPAs IT department. Working in cooperation with existing TPA systems ClaimsBridge adds powerful new features such as interfaces for the use of standard (i.e. 4010/5010) or proprietary EDI claim formats, automatic claim routing, repricing and claim scrubbing.

Finding and correcting claim processing issues can be a nightmare for the TPAs customer support function. ClaimsBridge provides the unified solution and centralized data warehouse readily accessible to customer support staff when problems arise. The ClaimsBridge Web Portal provides a user friendly claim search engine with complete details of claim routing and claim content necessary to identify and correct issues rapidly.

The ClaimsBridge approach eliminates multiple, duplicate manual and electronic claims entry functions which will reduce both costs and the opportunity for content errors. It will further reduce the claim rejection volumes and processing turn-around-time. The ClaimsBridge technology solution provides all participants in the healthcare claims process, including the TPA, with a financial benefit while simplifying their business processes.