
Rudd and Wisdom, Inc.
Software Division
9500 Arboretum Blvd., Suite 200
Austin,TX 78759
Main Phone: (512) 346-1590
Main Fax: (512) 345-7437
info@ruddwisdomsoftware.com
The Health Claim Adjudication module integrates with the existing QL.Admin claim and payment functions. Claims are accessed directly through the claims tab in Policy Display or the claim function in Policy Maintenance.
The claim adjudication window shows all claim details for each service phase. As with other system information windows, claim memos can also be added for adjustor and policy service reference.
Detail and summary claim information includes:
The benefits payable for each service phase are automatically calculated. The claim goes through an extensive validation process to confirm plan and benefit limits, usual and customary fees, co-insurance amounts, precertification, adjustor pay limits, adjustments and date ranges.
All of the supporting data for the Health Claims Administration Module are established and maintained in the Health Tables in the Data Maintenance menu. These data tables store adjustor and provider information, claim adjustment codes and pending codes.
All the while, the Health Claim Module integrates seamlessly with client and agent management, billing and premium, accounting, reporting and configuration of the base QL.Admin program.
The QL.Admin Reinsurance Module accommodates all aspects of a reinsurance treaty and allows different requirements for base plans, riders, coinsurance allowances, retained/ceded minimums and carriers.
Reinsurance details are displayed at the policy level for business with ceded amounts of coverage, along with a Reinsurance billing history for the policy.
If the user does not have the Reinsurance Module installed, then the Reinsurance Tab will not be included in the Policy Display or Policy Edit windows.
The additional modules for QL.Admin are sure to enhance the functionality of your system and benefit your insurance administration. Call 512-346-1590 to schedule a demo.