Eligibility Requirements Gathering
CHCS Services utilizes a highly technological imaging solution to rapidly manage the gathering of eligibility requirements for your members.
Support of Suppressions/ Contestability
The examiner assigned to your account has access to your policy definitions, ensuring access to underwriting documentation, the schedule of benefits and open lines of communication with your identified account team.
Customized Inquiry Response
CHCS Services will establish a customized inquiry response solution to meet all of your member’s expectations, answer questions and provide communication according to your organization’s guidelines.
Adjudication
Adjudication for your members claims are managed with our automated claims system providing claim payment calculations based on policy form benefits. For Medicare Supplement claims administration, CHCS Services maintains a Coordination of Benefit Agreement (COBA) and receives claims electronically from CMS daily. Utilizing smart system edits, 95% of these claims are auto-adjudicated.
Fraud Detection
CHCS Services requires that all case managers and claims examiners are trained to recognize the “red flags” for fraud and report it to the appropriate investigative teams.
Re-pricing
CHCS Services claims repricing services ensures that your claims are processed faster and with increased accuracy according to your organizations eligibility and plan benefits.
Pre-Certification
When care management pre-authorization of services is incorporated into the claims process, the invoices submitted by the providers are validated against the pre-certification data to ensure that the CHCS Services contracted hourly rate and recommended plan of care for services are verified.
Access to our Nationwide Provider Network
CHCS Services includes access to our nationwide provider network as part of your selected claims solution. To learn more about our provider network and benefits to your claims organization click here
Independent Audit Services
CHCS Services, through our specialized claims audit teams, provides independent audit services by offering complete analysis, evaluation and recommendations for your existing claims operations.