eCAMS Claims Management

eCAMS Claims adjudication managementEnhance visibility, ensure transparency and implement flexible benefit plans that evolve with your services. Our eCAMS Benefit System provides a robust and comprehensive framework for the design and implementation of benefit plans for your members. The cornerstones of the benefit management features include:

  • Benefit Plans - Tailor services to your members with our benefit plans features. Benefit plans can support specific managed care programs. Designing is easy with our step-by-step business process wizards. The plans implement the benefit service packages to define covered services, but also define RAC codes to establish which category of clients can use the specific benefit health plan. Benefit plans include other characteristics such as rates, capacities, assignment factors and coverage areas. Multiple benefit plans may be implemented in the system.
  • Benefit Service Package -The Benefit service package defines a bundle of services, diagnosis codes and delivery settings. Our system provides the flexibility to maintain complex benefit packages with rules to include and exclude services. A member may have more than one benefit service package at any given point of time based on their eligibility. Further, these packages can be associated and reused with more than one program. The same benefit service package can be linked with regular fee-for-service programs such as breast and cervical health or managed care programs. Benefit service packages are time dominated with start and end dates to implement automatic time constraints.
  • Group Structure - Our flexible group structure provides the flexibility to support exception based processing based on categories of members.
  • Business Rules Driven Benefits Evaluation Process - Our integrated RuleIT rules engine manages the business rules associated with evaluating the claim against the multiple benefit service plans and packages, determining hierarchy among benefits plan and benefit service packages and handling exception logic for unique situations.
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