Email info@claimsbridge.com  Phone (410) 349-3222

Preferred Provider Organization (PPO)

To stay competitive in today's healthcare market, PPOs must constantly focus on offering superior services at competitive prices. One key to offering superior service is to support a superior network of providers, one which attracts employers and providers alike. The key to keeping costs down is to manage this network of customers and providers optimally. ClaimsBridge® helps PPOs in both of these tasks.

PPOs who use ClaimsBridge can easily extend their network to include new providers, repricers and TPAs, thus offering new services to potential new customers. With ClaimsBridge as the connecting tool, each entity in the health network recognizes economies of scale, making each entity more responsive to its clients and more cost effective.

ClaimsBridge eases the claims adjudication process for PPOs by extending the power of a PPO's IT department. Working in conjunction with existing systems, ClaimsBridge adds powerful new features such as the use of standard or proprietary EDI claim formats, claim scrubbing, and repricing.

PPOs must apply a number of business rules and checks for every claim they process. ClaimsBridge helps PPOs manage and perform these functions efficiently.

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CAPABILITIES

  • Automatic & manual repricing

  • Paper to EDI

  • Clearinghouse connectivity, unique payer IDs

  • Verify subscriber's eligibility

  • Verify provider's name and participation

  • Routing services, including payers, wraps and other third parties

  • Forward fully pre-adjudicated claims to payer or TPA

BENEFITS

  • Predictable, cost effective solution

  • Faster claim processing times

  • Increased productivity

  • Single integrated solution

  • Improved provider relations

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(410) 349-3222
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