Health Plans, Inc. recently implemented a multimillion dollar claim processing and managed care software system developed by ERISCO, a nationally recognized leader in the claims software and managed care industry. Here are a few of the important benefits our clients are getting from this unique system:

EDI: Electronic Data Interchange

Health Plans, Inc.'s claim system, linked to regional and national electronic service centers, allows claims to be submitted electronically directly from the hospital or physician's office. The claim is automatically adjudicated after it passes certain payment criteria. EDI assures accuracy, speed and accountability.

Determining Appropriateness of Medical Procedures

Another source of increased cost in utilization occurs when healthcare providers charge for procedures unwarranted by the medical diagnosis. Health Plans, Inc.'s sophisticated electronic system detects and controls this utilization problem. The system effectively screens abusive billing practices. Our clients realize significant savings through this managed care technique.

Cutting Edge Reporting Technology

The final step in benefit management comes from effective and useful reports. Health Plans, Inc. has invested heavily in mainframe hardware systems and has developed software reporting technology that tracks the many complex transactions that make up healthcare costs.

Medical Style of the Future

High tech firms expect a high tech approach to healthcare and cost control. One such example of controlling costs is a system that detects utilization abuse coming from incorrect coding and unbundling of medical cost procedures. Health Plans, Inc.'s software offers a sophisticated electronic review procedure that detects incorrect coding practices. Claims are calculated and paid using the appropriate global procedure codes. The result: thousands of dollars in savings.