We developed and built our industry leading, proprietary software called ClaimsWare™. ClaimsWare has commercially been available for 15 years and core to our success as a TPA leader and innovator. As a result of our expertise in claim system design and functionality, our clients feel secure in our ability to process claims accurately, quickly and efficiently. It has significant software intelligence that provides detailed edits necessary for claim processing. Edits such as multiple surgeries, duplicates, bundling and unbundling, age and gender may be customized to allow for a variety of claim review options. In addition, since we own the ClaimsWare software, it can be customized to incorporate additional edits such as provider types, place of service edits, dollar limits and other parameters. While the ClaimsWare system carefully identifies these traditional edits, it can also add client specific programs and edits.

ClaimsWare Supports

  • Unique and innovative plan designs
  • Reference based pricing
  • Member-centric plans
  • Narrow networks
  • Centers of Excellence network strategies
  • Custom networks
  • Medicare + Pricing

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