Intelligent Medical Network Administration

11-04-2012 |

TPA or Insurance companies can only provide high quality of services through a wide spread, cooperative, reliable and robust medical network. E-TPA system allows TPA or Insurance companies to smoothly manage large as well as small medical networks.

Electronic Medical Network Administrator features

  • Geographical Analysis of the medical network
  • Distributes the service providers by type over the covered geographic area
  • Identifies locations with weak coverage; that require attention and suggests the missing types of providers

Seamless contract management:

  • Online membership requests
  • Provider Types, Specialty, groups and classifications
  • Specific or rule based service pricing, rebates and taxes
  • Permitted services and claim types definition
  • Contract history  tracking

Fraud and abuse detection

  • Potential Fraud detection reports
  • Flagging Provider for investigation
  • Following up on providers and updating investigation result
  • Broadcasting investigation results to concerned departments

Advantages

  • Allows full control and supervision over the medical network
  • Reduces Fraud and abuse
  • Fast membership requests processing