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| MedPOINT Management provides prompt, efficient claims processing services for our contracted IPAs and medical groups. Our experienced staff is familiar with Medicare (CMS), Medi-Cal and Commercial regulatory requirements, including claims timeliness guidelines, and claims are processed accordingly. MedPOINT Management utilizes OAO Healthcare Solutions EZ-CAP™ system to log, adjudicate, and pay claims. EZ-CAP™ provides full automation for both professional and hospital claims entry, adjudication, and payment with an online and batch claims management application. Using EZ-CAP™, MedPOINT Management is able to customize member eligibility information, benefits, and pricing rules to automatically adjudicate claims based on contract specifications between different IPAs and health plans. The integrated data loading capabilities of EZ-CAP™ allow our claims processors to manually enter only a minimal amount of data which maximizes daily production.
The EZ-CAP™ claims processing module allows for electronic data interchange which can be supported in multiple formats. This feature can be customized based on the provider's practice management system. Our IS staff works directly with the provider's office staff to determine the appropriateness of this type of submittal.
MedPOINT Management supports in-house recovery procedures to identify and recover lost money on insured services, reinsurance, overpayments, Third-party liability, coordination of benefits, and retroactive terminations. Our claims staff consistently and actively pursues recoveries on behalf of our providers and members.
Most importantly, the staff of the Claims Department is committed to providing timely and courteous Customer Service Responses. Our payment turnaround times consistently fall within accepted industry benchmarks, and we conduct back-end claims audits to avoid overpayment of claims and ensure that each claim is paid according to contracted rates.
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