Features of MediClaims Include:

Claims

  • Claims processing for medical, dental, vision, and prescription drug plans
  • Claim precertification, referral, and case management functionality
  • Capitation maintenance and payment processing

Administration

  • Consumer-driven healthcare benefit administration, including FSA, HRA, and HSA
  • COBRA administration
  • Eligibility administration
  • Disability processing for both short and long-term benefits
  • Premium billing and agent commissions
  • Easily configurable system security

Data Management

  • Customer service contact management
  • An extensive library of standard and custom reports
  • HIPAA-compliant EDI 5010 and legacy 4010 transactions
Claims Processing and EditingAdministration and BillingCompliance and ReportingConsumer-Driven HealthcareSecurityWeb Portals

Claims Processing and Editing

WLT’s user-friendly interface and EDI processes, in conjunction with our processing engine, allows claims to be processed quickly, accurately, and easily in real-time.

MediClaims’ processing and editing capabilities encompass a range of claim functions from:

  • Standard Medical, Dental, Vision and Prescription Drugs
  • FSA
  • HSA
  • HRA
  • Disability
  • HMO Capitation
  • Medicare Supplement

Utilizing our state-of-the-art EDI processes allows users to attain Real-Time auto-adjudication rates as high as 90%. Electronic Funds Transfer improves cash forecasting and cash flow, streamlines transaction processing, reduces operating costs and improves your business relationships.

Administration and Billing

The MediClaims system’s intuitive user interface simplifies the administrative duties of the Benefit Administrator. Precertification, Eligibility, PPO Administration, Letter Writing, and Call Tracking are just a few of the many features designed to save you time and money. WLT’s flexible plan design allows you to have multiple plan options at the group and individual level.

The Premium Billing & Agent Commissions portion of our system allows you to effortlessly bill for premiums and collect payments. Billing can be performed at the group, location, or even the individual level, and to top it off, distributing commissions for collected premiums is also made easy. Your organization will have the ability to maintain an unlimited number of agents participating in a single collected premium, as well as the ability to establish and utilize agent hierarchies in the calculation of commissions.

Compliance and Reporting

WLT understands that a critical aspect of a benefit administrator is its compliance with various federal laws. Therefore, WLT continuously monitors evolving federal requirements to determine how to help automate the required processes through our system’s functions.

Some of our compliance features are:

  • COBRA Qualifying Event Notification Letters
  • PCORI and Transitional Reporting for ACA
  • 1094-C & 1095-C Forms and Electronic Filing
  • HIPAA EDI Compliance
  • 835 CAS Reason Code Mapping
  • 835 RARC Code Mapping
  • 1099 Forms and Electronic Filing
  • W-2 Forms and Electronic Filing

Consumer-Driven Healthcare

The popularity of consumer-driven healthcare plans has been on the rise in recent years. WLT’s MediClaims system has the ability to easily administer these plans and incorporate benefits with your health plan. Some of the features of our Consumer-Driven Healthcare (CDHC) module include:

  • Flexible Spending Accounts (FSA)
  • Health Reimbursement Arrangements (HRA)
  • Health Savings Accounts (HSA)
  • Automatic FSA payments for health plan out-of-pocket expenses
  • Integrated HRA benefits in your existing health plans
  • Coordinate HRAs with your FSA plans
  • Administrative reporting and member statements that are specific to your FSA, HSA, and HRA plans

In addition to the above features, an integrated benefits card is available. The MediCard Benefits Card can be used by your members to settle point-of-service transactions directly from their available CDHC funds.

Security

All of your data is safely stored in the award-winning Oracle database and is exportable in virtually every format (Excel®, Word®, PDF, etc.) The databases are encrypted with advanced techniques to ensure your data’s protection, and MediClaims adds additional layers of security by customizing access to programs through multiple roles in the company. Authorized personnel can customize security configuration including:

  • User-defined roles
  • Access to programs
  • Access to individual fields within programs
  • Access to specific groups
  • Allowing view only or update capabilities within the above parameters

System security reports help authorized personnel identify every program a user can access, ensuring your configuration has the desired results.

Web Portals

Our Web Portals grant users an innovative, streamlined approach to benefit and claims management, while continuing the tradition of excellence our Clients have come to expect.

Full integration with the core WLT systems provides Real-Time data access, allowing for more dynamic automation of Enrollment, Member Registration, Call Tracking and much more.

Extensions

  • Document Management Solution

    Provides the ability to scan and attach documents and other images directly to an entity within the benefit administration system for easy indexing and access. You can attach documents to payer groups, locations, members, providers, and claims where they can be conveniently located and viewed at a later time when needed.

  • MICR Check Encoding (MCE)

    Reduces your overhead and increases productivity by using blank security check stock instead of higher priced pre-printed check stock. With Secure fonts, everything that needs to be printed on a check will be generated by the system, including the MICR line.

  • MediCard

    A Healthcare Payment Card that is compatible with most point-of-service systems. The card can be used to access funds from a Consumer-Driven Healthcare account such as Flexible Spending, and gives members the ability to automatically settle medical bills at the checkout counter.

  • EDI Trading Partner Connections

    Used in the integrated EDI routing system that allows you to automatically send and receive eligibility and accumulator data, claims, provider files, and more, directly to and from your trading partners (e.g. PPO, PBM). We can work with your trading partners to establish a real-time, automated process.

  • Benefit Plan Informatics

    A robust web-based reporting and analytics tool, providing customized health plan data analysis. BPI is designed to help administrators maximize the performance and minimize the cost of employer-funded plans. It identifies cost drivers and specifies how, when and where the money is being spent.

  • Repricing Solution

    This extension was designed with cost-containment and other repricing organizations in mind. With the Repricing Solution enabled, you will be able to manage claims from a payor for repricing services and be able to produce invoices based on a percent of savings or an allowed amount.

  • Eligibility Import Management

    A function used in conjunction with EDI eligibility import functions to manage and monitor eligibility changes received electronically. It allows you to view / edit imported eligibility data in the EDI tables before you actually move the data into production. Data is imported using the HIPAA 834 5010 layout, a WLT proprietary enrollment layout, or a custom layout.

  • 1094 / 1095 Reporting Solution

    This extension produces the ACA reporting forms 1094-C and 1095-C. In addition, you will be able to produce the 1094 / 1095 electronic file for submission to the IRS.

Discover The Advantages Of Our Systems

In order to see first-hand the difference how our systems can help you save time, costs, and increase your operations’ compliance, share your contact information and we will schedule a confidential demo session.