globalcentara Payor SM is an award-winning claims processing solution. The intelligent rules-based engine has built-in modules that will help you manage your health plan.
Reduce Manual Intervention
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Built-in intelligent rules based engine re-prices or auto adjudicates claims without manual intervention
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Processes payments for all types of provider contract rules and exceptions, flexible and efficient.
Increase Operational Efficiency
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Integrated Microsoft® BizTalk Accelerator for HIPAA to handle all electronic medical transactions mandated by the government. Eliminates the cost of a third party clearinghouse.
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Built-in member services, tracking and benefits management.
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Built-in premium billing.
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Built-in credentialing, UR, case management, clinical protocols that utilize reportable, stored database fields.
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Built-in Web Portal to allow providers and members to access claims status, eligibility or pre-cert.
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Capitation processing/eligibility roster management. Process sub-cap for providers.
