Medicare Supplement Insurance

Claims Adjudication

We believe that insurance administration should be easy and intuitive, while at the same time be comprehensive, reliable and adaptable. With this in mind, we created the QLAdmin Medicare Supplement auto-adjudication claims engine to better serve those companies operating in the middle income market.


QLAdmin can help improve claims processing efficiency and lower operating expenses with accurate real-time auto-adjudication. While the claims process can be complex, it’s not complicated with QLAdmin as your technology partner.

 

Claims Dashboard

Unique to QLAdmin, the claims processing dashboard displays real time adjudication rates and file processing results. 

  • Overall adjudication rate

  • Claims in queue and processed

  • Rejected claims and missing information

  • Drill down to policy EOB and payment detail

  • Rolling 30 day history of claims processed

  • Scheduling and administration tools

Business Rules Engine

For Medicare Supplement plans being administered, individual plan benefit settings are selected based on the company's processing guidelines. 

  • All plans in all states are supported

  • Plan settings determine deductibles, co-insurance, excess, etc

  • Map bill codes and procedure codes 

Manual Claim Queue

For those claims that are rejected during the auto-adjudication process, the claims processing queue enables quick review and manual adjustment to finalize the claim.

  • Policy and claim number detail

  • Service line, plan code and benefit code detail

  • Exception reasons are auto-notated in for quick resolution 

Rate Increase Management

Unlike other auto-adjudication systems, QLAdmin has a built in rate increase management tool. All rate increase filings by plan and by state are easily tracked with approval validation before rates are updated and policies affected.

 

Each rate increase allows the business user to drill down to each individual policy included in the increase and displays premiums and increase percentages.

QLAdmi Medicare Supplement clams lifecycle

"We're processing claims faster, more accurately, and with less staff with the QLAdmin claims module, resulting in lower claims administration expenses."

-Darrell Davis, VP Medicare Supplement Operations, Individual Assurance Co.

With high volume auto-adjudication, speed and accuracy are essential.

Click image for MedSupp brochure.

QLAdmin Solutions life insruance policy administration software.
9500 Arboretum Boulevard
Suite 220
Austin, Texas 78759
512-645-2990

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