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For payers interested in reducing administrative costs while increasing data integrity and accuracy, PPOplus has the capability to electronically receive claims from its providers through WebMD, the nation’s largest electronic claims clearinghouse, and electronically return them to its payers. Electronic claims returned to payers can either be returned through WebMD or through PPOplus’ Electronic Claim Mailbox (ECM) System.

PPOplus currently receives 82% of its claims from providers electronically. The remaining 18% of claims that we receive in paper form are scanned (OCR), edited and turned into electronic claims. The claims are then repriced and ready to send back to payers electronically. Unlike some PPOs that are returning just the repricing information electronically, PPOplus returns the entire HCFA and UB with the repricing on it so that when a payer pulls the claim up in their computer system the claim is ready to be adjudicated and no key punching is required. Industry studies show that payers save 17 – 25% per transaction when processing claims electronically.

FeaturesBenefits
PPOplus handles claims repricing
  • Simplifies procedures
  • Electronic Transactions delivered in a single file
  • Fee schedule maintenance eliminated for client
Timely and accurate data
  • Immediate access to current provider rates and demographic updates
  • Improves data integrity
  • Faster turnaround times – No mail costs
Time and administrative cost savings
  • Increases productivity
  • Speeds submission and processing of transactions
  • Minimizes errors and omissions
  • Eliminates double entry
  • Reduces rejected claims
  • Expedites claims processing
HIPAA compliance
  • Implements quickly
  • Increases productivity
  • Minimizes delays

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