Today's Risk Manager is under pressure to cut costs as well as manage claims. ECLIPSE BR has the most comprehensive rule validation logic in the industry to ensure dramatic cost savings above and beyond simple fee schedule application.
Comprehensive State Rules application is the core of the system. Working for you to control medical costs, ECLIPSE utilizes the most sophisticated logic in the industry for reducing medical bills to state-mandated fee schedules and for applying extensive state-specific rule validation. The incorporation of single, multiple or user-defined PPO reductions completes this fully automated process. Startech preloads the rules and values for each state in which you do business. (U&C state values are really available as well.)
Multiple PPOs means not having to select one nationwide network that may only offer modest discounts in exchange for nationwide coverage. Now you can contract with many PPOs, depending upon your geographic service needs. If you have your own negotiated rates with providers - no problem. You can easily configure ECLIPSE to apply reductions from your own custom PPO.
Pre-Cert Tracking Component enables you to manage and control the initial incident of claim. Based on the parent/child concept, each host/parent is given an unlimited number of child components for distribution to clients. When a claim is incurred, the incident information is logged, the pre-cert is made by the Physician and the information is then uploaded to the host system on a user-defined pattern of frequency. Extensive memo fields allow for note taking and journal entries.
Client Defined UR allows you to define a service category, e.g.: Physical Therapy, and determine claim-specific treatment plans based on your selected clinical guidelines. Warning levels can then be configured at any point in the claim process allowing for greater savings at the time of bill review. As an added feature, the EOR (Explanation of Review) can be configured to report back to the physician exactly where the injured worker is in relation to the specific treatment pattern modalities assigned. This allows for greater communication with the treating provider and greater control over the ultimate return-to-work objective.
Detailed EOR (Explanation of Review) is your documentation behind the reductions. Layout and design considerations have limited flexibility while output selections are virtually unlimited.
Extensive Data Validation exists for items such as duplicate claims or payments. ECLIPSE effectively preserves the integrity or your data, facilitating successful use by even inexperienced operators.
Review Bills by State whether you prefer state of claim or state of provider. You can also allow multiple physician locations per FTIN. Again, the system provides you with the flexibility to change.
Freeform Notepads offer ample space for documentation that can be attached to claims, providers and bills themselves.
State Defined EDI is available in any jurisdiction that has mandated the use of Electronic Data Transfer.
StarTech Software Systems, Inc., 39500 High Pointe Blvd., Suite 400, P.O. Box 8023, Novi, MI 48375. Tel: 248-344-2266; Fax: 248-675-2553.