Built for Precision: Smarter Adjudication and Flexible Workflows
QuickCap 7.26.2.0: For The Operational Flexibility Payers Need Every Day
Tiered Copay and Coinsurance at DOM Level
Accurate patient responsibility calculations based on tiered rates and maximum limits.
Negative Capitation Amount Handling
Track and carry forward negative capitation balances through an ‘organization CAP ledger’.
Authorization Creation from Case Management
Create authorizations directly from Case Management for streamlined workflow.
Contractor Status Rates for Medicare
Support Contractor Status C rates for Jurisdictions K and 6 under NGS MAC in standard Medicare fee schedules.
POS Identification on UB Claims by Revenue Code
Identify POS for UB claims using both ‘type of bill’ and ‘revenue code’ for improved accuracy and reduced manual effort.
Claim Auth Service Code Validation
Compare claim line service codes with attached authorization service codes and flag mismatches.
Manual Penalty Payment for Interest Arrear
Configure Interest Arrear & Penalty at the claim header level to apply applicable penalty amounts.
MSP File Generation Workflow
Process HEW files and generate applicable MSP files based on response files for MSP-eligible members.
Dental Fee Schedule on % of Billed Amount
Accurate patient responsibility calculations based on tiered rates and maximum limits.
Benefit Plan
Detail Option Maintenance
Benefit Rules
Support tiered copay and coinsurance configuration at the DOM level, including maximum coinsurance limits. Calculate patient responsibility more accurately based on configured tiered rates.
Capitation
PCP Capitation Processing
PCP/Specialty Capitation
Handle negative capitation amounts in the PCP/Specialty capitation process through an organization CAP ledger, tracking and carrying forward negative balances for future adjustments.
Case Management
Case Search
Physicians Details
Create authorizations directly from Case Management > Physicians Details to streamline the authorization process and maintain the linkage between case and authorization records.
Claims
General
Fee Schedule
Support Contractor Status C rates for Jurisdictions K and 6 under NGS MAC as part of standard Medicare fee schedules to improve Medicare pricing accuracy.
Claims Adjudication
Scanned Claims
Identify POS for UB claims using both ‘type of bill’ and ‘revenue code’, improving accuracy and reducing manual effort during claim processing.
Claim Authorization
Compare claim line service codes with the service codes on the attached authorizations and flag any mismatches to ensure accuracy.
Interest Arrear & Penalty
Configure Interest Arrear & Penalty at the claim header level to apply applicable penalty amounts when interest payment adjustments are required.
Eligibility
HEW Workflow Management
MSP File Generation
Process HEW files and generate applicable MSP files from received response files for MSP-eligible members, streamlining MSP file generation.
Contracting
Fee Schedule, Extended Fee Schedule, & Exception Extended Fee Schedule
Dental Claims
Support for the "D2 - Percent of Billed Amount" price basis in the dental fee schedule enables flexible, accurate dental claim pricing based on configured percentages.
