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Claims Solution

The NASCO claims solution is a multi-Plan, single-source processing solution for claims adjudication designed to reduce Plans' administrative costs. It encompasses total claims processing from online and paperless claims entry through payment generation for all lines of business and benefit levels. By automating and consolidating clerical functions, the claims system reduces paper flow, shortens processing time, and consistently and accurately applies benefits.

 

There are a number of benefits that the NASCO claims platform provides customer Plans:

  • Systems Integration - Eliminates the need for multiple claims submission and processes professional, facility, drug, dental, vision, and hearing claims. It also supports HMO, PFFS, PPO, POS, and CDH products

  • Web Enabled - Data entry with suspense correction, benefit determination, pricing, and COB processing are automatically performed in real-time, increasing data integrity and accuracy

  • Customer-Controlled Processing - Organized by a set of customer-controlled files, including group, subscriber, provider, procedure, diagnosis, benefit, administrative, authorization, pricing, COB, financial document messages, and post payment reconciliation files. Changes to benefits or guidelines can be quickly and accurately made by the customer Plan without programmer intervention

  • Multi-Site Processing - Multiple customer Plans are linked together allowing all Plans' claims to process through one integrated claims solution, providing consistent data elements and a consolidated database for reporting

The NASCO claims solution also supports Consumer-Directed Health (CDH) products and is fully integrated with banking and reconciliation functions. As part of this solution, claims information is passed to the CDH vendor based on the type of product selected, whether it's a Flexible Spending Account (FSA), Healthcare Reimbursement Arrangement (HRA), or Healthcare Spending Account (HSA). We also provide an administrative function for our Plans by reconciling the bank statements to the NPS.

 
Click here to view the
NASCO Claims Processing
brochure