Medicare Supplement Insurance
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.
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.
"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.