Claims Services
CNIC accepts
electronic physician and hospital claims
Average Speed to Answer (ASA) is less than 20 seconds with
100% documentation of incoming physician and members calls
CNIC's Claims Department is an important part of providing quality customer service to our clients and offers a variety of claims services (see links in right column for more details).
Our Benefit Analsyt staff each has over 10 years experience in customer service and claims processing within a self-funded, PPO environment and utilizing the RIMS® system. Both knowledgeable and accountable, our Benefit Analysts will provide you with the answers.
Electronic Data Interchange (EDI)
CNIC accepts electronic physician and hospital claims. CNIC endorses ENS (an electronic claims clearinghouse based in Colorado Springs, Coloardo). EDSS and CNIC are HIPAA compliant. Over half of ChoiceNet's claims will be processed through EDI by December 2001.
Access to provider claims status is available on-line.
Auto Adjudication
CNIC's claims system (RIMS®) offers customized edits allowing benefits to be programmed into the system. When claims enter the system, a sophisticated edit process occurs allowing greater than 40% of claims to be auto adjudicated and ready for payment immediately (without processor intervention). Claims that do not meet the edit criteria will be processed and adjudicated manually.
CNIC is noted for timely and accurate PPO claims administration. 95% of all medical claims will be processed within 10 days or less from date of receipt. Claims are processed with a 99% or greater accuracy level.
Single-Point-Of Contact
CNIC's Benefit Analysts (BA) provide single-point-of-contact for both customer service and claims questions. Our Benefit Analysts process claims accurately in accordance to the client's contract. In addition, they can provide benefit information, claim status, and PPO and Pharmacy Benefit Management (PBM) network information.
In order to provide premier customer service, CNIC is focused on answering your call quickly (in less than 20 seconds), documenting your phone call in our system, and resolve your issue through your initial call without the hassle of call re-routing.
Claims Management
CNIC's Benefit Analysts perform Coordination of Benefits (COB) and subrogation services, investigate pre-existing conditions and duplicate claims. Our system identifies any potential duplicate claim submissions for review.
Reporting
The CNIC administrative system offers unparalleled reporting capability. ChoiceNet uses the Monarch® reporting software system enabling access, extraction and reformatting of data (including graphical depiction of trends and more) through standard programs such as Microsoft® Excel, and Microsoft® Access.
CNIC offers a wide range of claims reports for our clients and re-insurers in order to effectively track trends. The reports are produced at varying levels of frequency (daily, weekly, monthly) and can be provided to our clients in an electronic format, if desired.
Auditing
Auditing of processed claims is integral to CNIC's quality control curriculum. Benefit Analysts are given payment authorization based on their experience in claims processing. CNIC's system automatically pends claims for review if payment authorization levels are exceeded. Review and release of these claims occurs within 24 hours. To assure accuracy, CNIC randomly reviews claims on a daily basis.
Additionally, our system incorporates an automated audit program to identify code bundling and unbundling.