eClusive handles back-office functions to coordinate payment for health plans
• Optimization of authorization process. Real-time access to in-network provider list and service catalog during ordering process. Automated communication to vendors. Authorization numbers generated and status tracked.
• Count downs of ordered services. Authorizations will drive the automation of matching claims to authorized services.
• Automate claims processing for electronic data interchange or paper claims. eClusive uses our TruChart technology to check each claim line for incorrect coding, duplicate services, invalid membership, unbundling of services and inappropriate modifier use.
• Pay Providers using desired payment method, EFT or checks. Health plan will approve all payments prior to release of funds. eClusive sends Explanation of Payment (EOP) correspondence or remittance advice.
• Pended claims are reviewed with health plan on a weekly basis. Pended process is based on authorizations, standard billing procedures, and customized rules.