Built for Control: Smarter Authorization and Streamlined Compliance
QuickCap 7.26.3.0: For The Operational Precision Payers Need Every Day
Bulk Termination Date for Authorization Batch Processing
Change the valid-to date of authorizations in bulk to reduce manual effort in authorization processing.
Claims Letter Attachments and
RPT-Based Templates
Attach PDF documents to claims letters and generate letters using new RPT-based templates.
Allowed Amount Override at Claim and Health Plan Level
Override the Allowed Amount at the claim level based on configuration set at the Health Plan level.
COVID-19 File Rate Integration into Standard Medicare Pricing
Apply CMS COVID-19 File Rates within the standard Medicare pricing workflow.
PCP ZIP Code-Based EEFS Pricing
Configure fee schedules using the member's PCP ZIP code for county-based pricing.
Sub-IPA Encounter Submission Workflow
Manage the entire workflow for encounters submitted by Sub-IPAs through a dedicated module.
Discharge Hour Reporting Configuration for Encounters
Configure Trading Partner parameters to define which Types of Bill require Discharge Hours.
PCP Accept New Patient Alert on Member Profile
Receive an alert when assigning a PCP whose linked location is not accepting new patients.
Multi-Channel Outreach Tracking for Medi-Cal Redetermination
View Email, SMS, and Voice Call outreach triggered for the Member Outreach Workflow.
EOB Generation for Voided Checks
Generate and store EOBs for voided checks for full claim and payment visibility.
Authorization/Referral
Batch Processing
New Valid-To-Date Change Option for Batch Processing
Change the valid-to date of authorizations in bulk directly from the Batch Processing screen, significantly reducing manual effort and improving efficiency during authorization processing.
Claims
Claims Adjudication
Batch Processing and Automation
Attach PDF documents and specific document categories to claims letters, including through Batch Processing and Automation, and generate letters using new RPT-based templates, improving communication completeness and streamlining dispatch workflows.
Claim Adjudication and Health Plan Maintenance
Override the Allowed Amount on individual claims using dropdown options available at both the claim adjudication and health plan levels, streamlining pricing logic and improving transparency into the configuration source used during claim pricing.
Contracting
General
New COVID-19 Rates Calculation for Standard Medicare Pricing
Apply COVID-19 File Rates provided by CMS within the standard Medicare pricing workflow and claims processing logic, ensuring accurate automated pricing for vaccine administration and related service codes.
Exception Extended Fee Schedule & Extended Fee Schedule
New Member’s PCP’s ZIP Rule Fields
Configure and evaluate fee schedules using the member's PCP ZIP code, ensuring accurate pricing for provider contracts that vary by PCP county.
EDI Services
277 Upload
Encounter Management
Allow delegated entities such as Sub-IPAs to submit EDI encounter files without unnecessary claims creation and adjudication, automatically combine encounter files for health plans, and route 277 responses back to the appropriate IPAs.
Trading Partner Enrollment
Trading Partner Configuration
Configure a Trading Partner parameter to define the Types of Bill that require Discharge Hours in Loop 2300, improving payer compliance and reducing manual workarounds and encounter rejections.
Eligibility
Members
Member Profile
Trigger a warning alert on the Members screen when a PCP whose linked location is not accepting new patients is selected for a member, improving data accuracy and preventing improper provider assignments.
Letter/SMS/Call Template
Create Template
Medi-Cal Redetermination Outreach
Display the Email, SMS, and Voice Call outreach triggered for the Member Outreach Workflow directly within the system, preventing eligible beneficiaries from experiencing procedural lapses in health coverage and reducing manual follow-up effort.
Payment Processing
Check Register
Enhanced Functionality for EOB Files of Voided Checks
Generate and store EOBs for voided checks, enabling users to seamlessly review and verify claim details and payments associated with those checks.
