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- Insurance Claims Processing
- Claims Adjudication Services
- PPO Repricing Services
- Forms Processing Services
- Insurance Fraud Detection
- EDI Integration Services
- Data Entry Services
Services » TPAs Services (cont..)
Specialized TPA Services:
Claims Adjudication
Fraud Detection
Eligibility Verification
Medicare Part D
Provider Maintenance
Flexible Spending Account
Flex Re-enrollment
Employee Maintenance
Pre-Certs
Case Management
Partner with VeeInsure to handle your claims adjudication process needs. VeeInsure has been adjudicating claims payments for Large Insurance Carriers and TPAs since 1999. Our claims adjudication capabilities and experience enable us to provide our clients with quantifiable gains in quality and operational efficiency. These are proven services and the clients of VeeInsure have continuously renewed contracts, enlarging the scope of work, with more complex and evolved processes. These include processes involving super/miscellaneous claims adjudication.
Fraud Detection
Provider matching is one of the most difficult challenges facing claims managers. An incorrect provider match can result in incorrect payment. VeeInsure’s provider matching process is done by utilizing sophisticated provider matching algorithms to improve accuracy and the "hit rate" of your match.
Eligibility Verification and Routing
VeeInsure provides specific services for our clients, where the eligibility information present on the claim does not match with the data present on the clients' proprietary system like Trizetto RIMS. VeeInsure eligibility experts analyze the claim to decide if the claim is eligible for payment.
Medicare Part D
VeeInsure employs specialists to handle pharmacy claims (Rx claims) where we analyze the details present on the prescriptions and feed the data into the client's proprietary system on various information such as Drug Code, NDC Code, Drug Name, Drug Quantity, charges etc.
Provider Maintenance / Credentialing
VeeInsure has expertise to maintain TPAs Provider database by adding new provider or modifying existing information every day based on TPAs comments. These changes or additions will take place by accessing TPAs RIMS server or COMPASS server or any other client server connecting through VPN or Internet. VeeInsure also specializes in Provider Credentialing.
Flexible Spending Account (FSA)
VeeInsure maintains the enrollee Flexible Spending Account (FSA) information. The following information is maintained for a flex type, group, and enrollee for the current or prior flex year: Contributions, Expenses, Payments, Available Contributions, Enrollee comments.
Flex Re-enrollment
VeeInsure handles the Flex Re-enrollment Process for TPAs during the annual flex re-enrollment period. This process includes updating the employee, dependents information along with the coverage details.
Employee Address Maintenance
VeeInsure maintains the demographic details of all the Employees of the TPA's clients. These details are maintained by accessing the TPA's RIMS/Compass server. When the TPA despatches the EOBs or Intimation Cards to its clients the USPS sends back address cards for which there were unsuccessful despatches. VeeInsure Updates the Employee Addresses for all the returned mails.
Pre-Certs
VeeInsure handles the Pre-Certifications (Pre-Certs) work for the TPA by adding required information like ICD9 codes, Date of Service, Number of Certified days and provider information into RIMS. VeeInsure also handles the Referrals.
Case Management
VeeInsure manages cases where critical information needs to be loaded in to the RIMS. TPA sends Vee the list of cases on a daily basis. Vee Case Management Specialists access into the ENF screen of RIMS to input specific data related to some of the cases notified.
Try the VeeInsure experience.!! Its worth it. Please call us on 1-312-373-9346 or email at
