Payment Determination and Management
NASCO is committed to providing accurate and prompt benefit reimbursement to members no matter where they live, work or travel. NASCO is also committed to providing accurate reimbursements to a Plan’s network of providers, regardless of the contractual arrangements or network configurations. Our foundation is our claims processing system, and we continue to enhance our base claims solution with new products, improved capabilities and increased sharable services to ensure that our Plan customers remain competitive and aligned with changing market demands.
NASCO easily processes claims for national, local and government business, including small group, large group and individual accounts, on one system platform. This single system allows Plans to eliminate redundancy and share the costs of development and maintenance. With the ability to automatically adjudicate over 90 percent of all claims processed, the system is built to handle large volumes and complex business, and it is unsurpassed in the market for reliability, flexibility, scalability and operational performance.
Navigator for Claims
Navigator for ClaimsSM is NASCO’s state-of-the-art claims inventory management solution. The solution, which is built on Pega’s industry-leading Claims Workstation Framework, enables Plans to obtain more value by optimizing pended claims inventory management.
Navigator for Claims goes beyond work distribution, supporting performance management through intelligent workflows that streamline processing, workflow and operational management of pended claims. Navigator for Claims empowers business users to configure rules and SLAs to manage claim queues and execute skill-based routing. These capabilities enable Navigator for Claims to get the work into the right hands at the right time, which delivers optimal efficiency, quality and value to our Plan customers.
The NASCO Payment Engine (NPE) is designed to support various non-claims-based payment calculations. The solution uses Member, Provider and Benefit Co-pay data extracts from the NPS and other source systems to generate capitated provider payments to providers and vendors. Plans have the ability to configure payment programs using an intuitive Web-based user interface.
The NPE supports multiple types of payments to providers and vendors, including per-member-per-month capitation payments, monthly care coordination fees to compensate providers for care coordination responsibilities, monthly administrative fees to compensate providers for care management services above and beyond care delivery, and quarterly or annual incentive payments for attaining performance-based targets. The NPE can also be leveraged to perform periodic settlements, compute withholds and other debit or credit arrangements.