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IAC Launches Medicare Supplement Claims Auto-Adjudication System

January 22, 2018

Individual Assurance Company of Oklahoma City, Oklahoma, a long time QLAdmin Solutions client, reclaimed their Medicare Supplement claims administration by implementing the new Medicare Supplement Claims Auto-Adjudication module.



Austin, TX – January, 2018 – QLAdmin Solutions recently launched their newest module for the QLAdmin policy administration system; the Medicare Supplement claims auto-adjudication module. All plans in every state are supported including foreign travel. The first client installation for the new module was recently completed with Individual Assurance Company (IAC) of Oklahoma.


IAC has been a QLAdmin client since 2002, and this new claims module was the result of a strategic joint development project. In 2016, IAC’s president Jim Harlan approached QLAdmin Solutions with the project idea. As QLAdmin was already integral to IAC insurance operations, developing a Medicare Supplement insurance claims auto-adjudication module to work with QLAdmin was key to the company’s future business expansion plans.


Darrell Davis, VP Medicare Supplement Operations, explains; “I have worked with QLAdmin and their staff for 15 years. Not only is QLAdmin the best policy administration software I have encountered during my 35+ years in the insurance industry, the people at QLAdmin are second to none in customer support and implementation services.”


The Medicare Supplement claims auto-adjudication module is an off-the-shelf solution that provides companies full adjudication capabilities for all Medicare Supplement plans in every state. Unique to the QLAdmin system is the user dashboard display which includes viewing real-time and historical processing metrics, drilling down to individual claims and payment details, and generating claims reports and notifications.


The additional key components are the Business Rules Engine, Rate Increase Management tool and Manual Claims Queue. These business user interface tools work together to provide companies complete control over plan and benefit processing, rate increase implementations, and claim exception settlement.


At the heart of Medicare Supplement claims system is the independent auto-adjudication engine, which enables rapid processing of 800 to 1000 service lines per minute. Multiple processing agents can run at the same time, 24 hours a day, and each is continuously queuing claims files for batch processing. And once individual files are processed, they are archived for as long as needed.  


Like many insurance companies in the MedSup business, IAC had long used a Third-Party Administrator (TPA) to handle the complex claims processing and benefit payments for their Medicare Supplement insurance business. Bringing this business back in house and establishing an expert claims department was a pivotal yet economical strategy for IAC’s future business model.


Within the first month of launching the QLAdmin auto-adjudication module, IAC realized adjudication success ratios ranging from 94% to 96%, and claims staff were extremely pleased with the efficiency in overall processing.


“We’re processing claims faster, more accurately, and with less staff with the QLAdmin claims module, resulting in lower claims administration expenses,” says Davis.


About Individual Assurance Company – IAC is headquartered in Edmond, Oklahoma and operates in 43 states and throughout the Pacific Island Nations and Territories. IAC is led by President and CEO Jim Harlin. With nearly 8 billion of insurance in force, IAC maintains a “B+ (Good)” rating with A.M. Best Company. IAC continues to grow through the years by being “Focused on what matters most.”| 800-821-5434


About QLAdmin Solutions – QLAdmin Solutions Inc. is a software company of insurance experts that enables insurance providers to succeed in their markets. For 30 years, QLA has provided complete, end-to-end life insurance policy administration software solutions. Today, over 45 insurance companies, fraternal benefit societies, and mutual companies use QLAdmin and related system tools. QLAdmin Solutions is headquartered in Austin, Texas.| 512-645-2990


View the press release here.




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