Claims Administration gives insurers an integrated approach for each step of the claims process, including notice of loss, data capture, policy and coverage verification, financial processing and workload management.

At Dpro Technologies we provide this service in 3 main stages:

• Pre-Adjudication.
  • Member Patient Detail Verification.
  • Provider Detail Verification.
  • Provider Maintenance.
  • Verify and Validate Claim Details.
• Re-Pricing.
  • Re-evaluate the expenses submitted in the claim.
• Adjudication.
  • Verification of Diagnosis, Pre-existing Conditions, Pre-authorization, eligibility, accident investigations etc.
  • Verification of Eligibility Charges and exclusions from Policy Document.
  • Payments.

Benefits:

• Reduce claims expenses.
• Improve customer service.
• Review claims data more accurately.
• Reduce costs by reducing claims cycle times.
• Increase in both claims caseload productivity and post-claim renewal retention.

Highlights:

• Experienced in processing HCFA, UB, Dental & Non-Standard Claims on a variety of claims systems
• Experienced in claims administration for Flexible Spending Accounts (FSA), Health Saving Account (HSA) & Health Reimbursement Account (HRA)
• We also have experience in providing services to Consumer Directed Health Plans (CDHP)
• Highly skilled and experienced professionals who have been trained on multiple plan designs and platforms