Claims Processing

Claims processing system designed to help us excel in our service commitment.

Zenith American Solutions claims system offers these key functionalities to support health care benefits management:

  • PPO Re-pricing
  • Medical Management
  • Claims Adjudication
  • Customer Service
  • Claims Editing
  • Electronic Data Interchange (EDI)
  • Claims Payment
  • Reporting and Analytics
  • Eligibility
  • Consumer Driven Health Care (CDHC)
  • Plan Management
  • Loss-of-Time (Short-Term Disability)

Integration with several services such as:

  • Reporting and analysis
  • EDI
  • Scanning and document management
  • Financial services for payments and receipts
  • Internet based services – websites, email, etc.

Features include:

  • Flexibility to change and support multiple client-specific processing requirements
  • Logic engines and features that enable processing customization and automation
  • High auto-adjudication rates and integration with EDI services
  • Demonstrated large scale success
  • HIPAA compliant transactions including code sets, privacy and security
  • Open Systems Environment – the ability to interoperate and share information across platforms
  • Multiple rate tables and Medicare edits consistent with industry standards
  • Facilitating the administration of increasingly complex benefit plans and regulations
  • Providing an outstanding platform for data exchange between client vendors (e.g., disease management, wellness, etc.)
  • Allowing for significantly improved data collection, tracking and reporting

To request more information please send us an email.