HEALTHCARE BPO SERVICES
JMS specializes in claim processing solutions for both paper and electronic claims that reduces both provider and claim payer costs and turn-around. These solutions provide relief for backlog conditions, managing peaks and valleys, HR and Training management, quality of data, and inventory turnover. JMS implementation planning will provide your company with a proven professional approach to transitioning claim processing to an outsourcing model. Experienced JMS claims managers and project managers provide daily production support and guidance to streamline the conversion and provide clear communications.
• MAIL ROOM SERVICES
Receiving paper claims from payer or provider, opening mail, separating claims, counting, sorting and batching in preparation for document scanning and imaging.
• SCANNING & IMAGING
Documents are scanned to provide a digital copy of the paper claims and attachments. Multiple page claims are concatenated into a single image file for simple retrieval.
• DATA EXTRACTION
JMS employs a Double Key and Third Verification data extraction process. The data is keyed by two independent data entry operators. If the system identifies a difference in the data a third operator verifies to provide the highest level of accuracy. Red Drop-out form claim data can be extracted electronically through our OCR software and manual verified to guarantee the highest level of accuracy.
• DATA VALIDATION
By using an extract of the payers Provider and Eligibility files combined with the client business rules. To improve auto adjudication rates JMS can either systematically or manually repair claim data, allowing your incoming claim data to match up with data contained in your claim processing system.
• EDI CLEARINGHOUSE SERVICES
Streamline incoming EDI files submitted by Providers and PPO Networks, and reduce your clearinghouse costs by implementing the JMS Clearinghouse solution.
• NETWORK ROUTING
Manual Web or Electronic (EDI) processing is performed by routing your claims for processing to PPO Network(s).
• CLAIM REPRICING
Single Source Repricing is provided through Manual Web Lookups, Network EDI Routing, or Fee Schedule matching to your captured PPO Network(s).
• BILL REVIEW
Data entry of claims and bill review processing that reduces paid claim errors related to Workers Compensation and Liability industries.
• COST CONTAINMENT
Out-of-network claims are serviced through travel networks or manually negotiated ton a case-by-case basis and Fraud Detection services identifies incorrectly billed claims. Ancillary Claim Discounting services provides the highest level of discounts available in the industry.
• ADJUDICATION SERVICES
JMS examiners access the clients system through a remote and secured connection to perform Claim Review, Claim Auditing, Data Verification, Overpayment and Refunds, and Claim Approval or Denial based on individual or group plan designs and requirements.
• PROVIDER AND MEMBER MAINTENANCE
Updates are managed to keep provider and member data current and accurate. NPI uploads to support HIPAA compliance. Provider Cleanup services identify and flag duplicate records.
• DEPENDANT AUDIT
A complete review and certification of all dependents. In addition to a number of standard validations, the audit verifies the eligibility of each dependent via the collection of birth certificates, marriage certificates or other employer-required documentation.
• Plan Testing
Testing the programming or logic accuracy for plan benefits, in any system, is a rational progression from knowledge gained in adjudication and audit of plan benefits. JMS currently has a pool of over 50 full-time trained examiner level personnel and experienced claims manager available to transition into the plan testing service offering. This type of service is offered as a one time support option and also an ongoing support option depending on Client practices.
• CLAIM & MAIL WEB-HOSTING
Provides a secure environment to view paper or electronic facsimiles of your incoming claims and mail from any remote location that has access to the internet.
• STORAGE, RETRIEVAL, & SHREDDING
Paper claims and documents are stored in a secure storage environment, paper copies or originals are available upon request and can be distributed via mail delivery, email, or fax. Documents can be shredded after your paper retention period expires. All shredded paper documents are used for recycling purposes.
Receiving paper claims from payer or provider, opening mail, separating claims, counting, sorting and batching in preparation for document scanning and imaging.
• SCANNING & IMAGING
Documents are scanned to provide a digital copy of the paper claims and attachments. Multiple page claims are concatenated into a single image file for simple retrieval.
• DATA EXTRACTION
JMS employs a Double Key and Third Verification data extraction process. The data is keyed by two independent data entry operators. If the system identifies a difference in the data a third operator verifies to provide the highest level of accuracy. Red Drop-out form claim data can be extracted electronically through our OCR software and manual verified to guarantee the highest level of accuracy.
• DATA VALIDATION
By using an extract of the payers Provider and Eligibility files combined with the client business rules. To improve auto adjudication rates JMS can either systematically or manually repair claim data, allowing your incoming claim data to match up with data contained in your claim processing system.
• EDI CLEARINGHOUSE SERVICES
Streamline incoming EDI files submitted by Providers and PPO Networks, and reduce your clearinghouse costs by implementing the JMS Clearinghouse solution.
• NETWORK ROUTING
Manual Web or Electronic (EDI) processing is performed by routing your claims for processing to PPO Network(s).
• CLAIM REPRICING
Single Source Repricing is provided through Manual Web Lookups, Network EDI Routing, or Fee Schedule matching to your captured PPO Network(s).
• BILL REVIEW
Data entry of claims and bill review processing that reduces paid claim errors related to Workers Compensation and Liability industries.
• COST CONTAINMENT
Out-of-network claims are serviced through travel networks or manually negotiated ton a case-by-case basis and Fraud Detection services identifies incorrectly billed claims. Ancillary Claim Discounting services provides the highest level of discounts available in the industry.
• ADJUDICATION SERVICES
JMS examiners access the clients system through a remote and secured connection to perform Claim Review, Claim Auditing, Data Verification, Overpayment and Refunds, and Claim Approval or Denial based on individual or group plan designs and requirements.
• PROVIDER AND MEMBER MAINTENANCE
Updates are managed to keep provider and member data current and accurate. NPI uploads to support HIPAA compliance. Provider Cleanup services identify and flag duplicate records.
• DEPENDANT AUDIT
A complete review and certification of all dependents. In addition to a number of standard validations, the audit verifies the eligibility of each dependent via the collection of birth certificates, marriage certificates or other employer-required documentation.
• Plan Testing
Testing the programming or logic accuracy for plan benefits, in any system, is a rational progression from knowledge gained in adjudication and audit of plan benefits. JMS currently has a pool of over 50 full-time trained examiner level personnel and experienced claims manager available to transition into the plan testing service offering. This type of service is offered as a one time support option and also an ongoing support option depending on Client practices.
• CLAIM & MAIL WEB-HOSTING
Provides a secure environment to view paper or electronic facsimiles of your incoming claims and mail from any remote location that has access to the internet.
• STORAGE, RETRIEVAL, & SHREDDING
Paper claims and documents are stored in a secure storage environment, paper copies or originals are available upon request and can be distributed via mail delivery, email, or fax. Documents can be shredded after your paper retention period expires. All shredded paper documents are used for recycling purposes.