Automate claims collection from counties or other state agencies, etc.
County Claims e.g., Affordable Care Act, Children’s Services, Breast Cancer, Mental Health, etc.
Social Services e.g., adoption, child welfare, healthy families, food, etc.
Differentiate, classify, and validate claims according to type for Federal or State Participation (FFP, SGF) and/or other funding sources
Based on claim type, source, aid codes, medical eligibility group, etc.
Table-driven rules to allow insertion of new aid codes without costly software changes.
User-defined medical eligibility groups and/or other classifications by program.
Provide summary/detailed reports to adjudicate, validate, and track claims
Automated rules-based filtering and categorization/detailed
Workflow for claims processing
Success/Failure metrics
Claim level details with start/finish historical reporting
Apportion claims based on pre-defined allocation rules
By percent, multiple pools, contract rules, etc.
Table based to accommodate change, e.g., federal aid codes
Validate aid code percentages applied during adjudication
Invoice and distribute claims to funding sources with full audit trail
Electronically by EFT and/or wet signature
Specialized invoice by funding source with supporting/accompanying “backup” reports (MEG, FFP, etc.) automatically collated.
Participation metrics captured for later federal/state stakeholder audit reporting.
Track receipts from funding sources and reconcile claims
Exceptions, adjustments, liquidations
Invoice host (State or Agency) for non-participatory amounts
AR Cash receipts automatically release AP claim schedules for payment
Disburse funds to original claimants
Showing share of each participating funding source
Report warrant/EFT used to pay claim schedule down to the service provider and detailed claim level
