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Overview
ESP-Link™/HCS provides real-time claims processing, clinical evaluation and payment services for the health care industry. HCS supports and interprets the complex interdependencies among benefit services, health-care providers and patients to accommodate any health care benefit plan. Payers can process claims, define pricing lists and payment totals, and support management and application of preferred provider arrangements and industry claims, standards and protocols.
Services & Functions
Claims Adjudication
HCS uses a single Adjudication Engine to drive all claims through enrolment, eligibility and payment.
Benefit Plan Design/Definition
The adaptive HCS parameter and rule-driven architecture is designed to allow insurers to define and restructure benefit plans and policies easily.
Enrolment & Eligibility Management
Individuals eligible for benefits have system records, verified as part of the claim adjudication process. The system also supports plans where dependent enrolment is not required. A record of the individual's history of service is attached to each file.
Decision Support/EIS
HCS provides comprehensive decision support and reporting and renders key information required for managed care and outcome management.
Benefit Utilization Analysis & Review
Benefit Utilization Analysis & Review of claims, including cost sharing and particular arrangements among the plan sponsors. The provider and the patient can be specified and HCS evaluates the services being claimed against a patient's past history to ensure the consistency of claim transactions.
Claims Payments & Statements
HCS processes all payments, manual or EFT, and supports the generation of payment statements and a full explanation of benefits to both providers and patients.
Clinical Analysis
HCS provides enterprise reporting, on-line analytical processing and pattern and relationship detection. Gain insight into benefit usage patterns, formulate fact-based strategies and anticipate market needs to gain competitive advantage.
Billings & Administration
HCS modules handle all billings and support administration and payment schedules for the Health Care Industry.
Provider/Customer Service
HCS improves customer service by providing more convenient, efficient, effective service with less paperwork, using a single engine across all benefit areas.
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