Medical Repricing Software

Autoadvisor is integrated medical repricing software with a managed care component for the auto medical claims market.

The auto claims software package offers a variety of integrated features which provide support for all the managed care needs of an auto medical insurer, including:

• a bill repricing function, which ensures that discounts from PPO networks, fee schedules and appropriate usual and customary pricing are captured and that duplicate and excessive charges are identified.

• interface between managed care and claims systems, enabling electronic exchange of data between systems via EDI.

• the ability to cross-reference attorney-to-physician referrals.

• the capability to compile more than 50 different reports that provide profiles of individual and network providers' treatment patterns and outcomes.

The software also features the capture and calculation of co-payments and deductibles, a user-configurable UR (utilization review) edit capability that allows companies to flag types of services which need to be modified or analyzed, and history reports which assist adjusters in claims settlement.

The product also contains a managed care module for use in utilization management and case management services. Case managers can access the entire medical claim history in a calendar format to better evaluate and direct the care plan. The system can also cross-reference a claim diagnosis to the medical bill diagnosis to prevent abusive claim practices.

HNC Software, Inc., 5930 Cornerstone Court West, San Diego, CA 92121. Tel: 619-546-8877; Fax: 619-452-6524.