AdjudiCare is an advanced, practical web-based software solution used by a network of Employee Benefits Brokers and Third-Party Administrator partners across Canada in the adjudication of health and dental claims. Our rules-based engine and leading-edge features ensure that claims are precisely adjudicated and paid in real-time, giving our partners’ customers optimum flexibility, along with transparent disclosure on the benefit plan’s financial performance.
HEALTH AND DENTAL CLAIMS
With its ability to recognize and manage any sort of claim, the AdjudiCare platform lets your clients process their health and dental weekly indemnity instantly and efficiently. Should the end-user client express concern over managing both fully-insured and self-insured plans with the same software, AdjudiCare handles both with ease. AdjudiCare’s platform is fully customizable, no matter how many companies you have to deal with, the benefits of private branding and custom identification keep everything confidential.
e-HEALTH AND e-DENTAL
Adjudication is done instantly from receipt of electronic submissions for both e-Health and e-Dental claims submissions – and both are processed in real-time.
Extended Healthcare Provider E-Claim Submission
Plan members want fast and convenient service and Symbility Health offers another cost-effective electronic healthcare claims solution to enable a more simplified claims experience. Through www.benefitsXchange.ca, extended health providers can submit plan member claims directly to Symbility Adjudicare from the convenience of their office - providing more value to plan members and their patients by reducing paperwork and out-of-pocket expenses. It also allows providers, TPAs & TPPs a more streamlined approach to the traditional way of processing claims.
The following healthcare providers are able to submit online claims directly to BenefitsXchange.ca on behalf of plan members: – physiotherapists, chiropractors, opticians and optometrists in all provinces; plus – massage therapists, naturopathic doctors and acupuncturists in provinces where they are provincially regulated, or if they are members of a professional association.
Overall, the ability to manage, view and access all client information at any given time enables you to provide your clients with the advantage of being in a position to offer them better business consulting decisions with products that precisely address their needs.
AdjudiCare addresses any costs or complications, which might normally result from adding the management of a Health Care Spending Account (HCSA) or a Cost Plus plan to a traditional health and dental plan.
Your partners stand to benefit by adding these easily-managed features which add a full complement of reports dedicated to HCSA reporting. Given its built-in HCSA functionality, it also supports pro-rated funding, manages carry-forward of funds, provides the ability to set a reimbursement level and adds the automatic ability to remove or dedicate funds to electronic dental claims.
FIRST NATIONS DESIGN PLANS
AdjudiCare means flexibility as evidenced by its ability to accommodate multiple plan designs. As applicable, the plan can be adjusted to coverage for First Nation and Inuit plan members. While basic coverage for regular insurance is supplied through provincial and federal governments, additional Non-Insured Health Benefits (NIHB) provides additional coverage. This applies to a specified range of drugs, dental care, vision care, medical supplies and equipment and short-term crisis intervention mental health counselling for First Nations and Inuit peoples.
AdjudiCare provides for easy management of eligibility while it automates and enhances the adjudication process for First Nations and Inuit clients as well as for blended families.
ONLINE CLAIMS ACCESS AND PORTAL
Add transparency and hands-on access and functionality for member and plan administrators. Symbility Health is thoroughly customizable to the business needs of your partners. They set the rules and dictate the degree of access that works best for them. From ‘who sees what’ to ‘how it all looks’, the AdjudiCare solution adapts to clients’ needs – and not the other way around.
From options including control over which members gain online Claims Access to the degree of automated information being sent to members, Claims Access is fully adaptable to any clients’ best practices. From control over the content of the User Interface graphics for a fully branded/customizable look, it’s the one benefits plan platform your clients can totally own and take pride in.
Member Administration Portal
Easy access for up-to-the-minute coverage status and pertinent member details. Employee claims can be viewed and filtered by category, benefit type, service date and payment details.
Plan Administration Portal
Degree of access defined by partners. Administrators can access claims reports, HCSA reports, Invoicing reports and Member Profiles reports.
Symbility Health’s Online Access and Portal platform provide total control on a personalized basis. Allowing employees to have real-time access to their own information saves time for administrators. Providing your partners with additional product options to maximize their plan is a giant leap forward competitively.
Not only does it make a positive Green statement, environmentally-speaking, but each partners’ employees can partake of an enriched plan they can call their own.