Medical Claims Management RDS Solution’s HIPAA Compliant Medical Claims Management System has been designed to be used by self-insured companies to process their employee's medical claims. Medical Claims Module The Medical Claims module can be used for medical, dental, mental, vision, time loss, death and dismemberment claims.  Key features of this module are: allows for multiple health plan support can processes up to three years of claims concurrently checks for duplicate claim and procedure allows for out of network and failure to pre-certify penalties uses standard medical coding for procedures, diagnosis etc. can use reasonable and customary checks on Medical, Dental, HCPCS, Anesthesia and Outpatient Facility procedures (ADP Context) electronic interface to Blue Cross and Blue Shield of Illinois interface for electronic feed of claims in HIPAA format (HIPAA_Link) has the ability to set yearly or lifetime limits on specific types of claims (either dollars or visits) allows for fixed rates on specific procedures deductible calculation is based on family and/or individual has a separate deductible for dental and orthodontia claims co-pay percentage is based on maximum out of pocket claims are entered immediately into the system and will remain in a hold status until processed automatically produces correspondence requesting missing or incomplete information from the employee produces deductible, denial and explanation of benefit letters to employee and service provider on-line claims inquiry screen Interfaces to General Ledger and Check Reconciliation Module. Prescription Drug Module Used in conjunction with the Medical Claims module.  Prescription drug claims are included in medical claim calculations for deductible and co-pay.  Additional features of this module are:  checks for duplicate prescriptions electronic interface to the Retiree Drug Subsidy Program Interfaces to General Ledger and Check Reconciliation Module. Check Reconciliation Module Updates check reconciliation file.  Key features of this module are: multiple company, location and banks reconciliation procedure to balance to bank statement provides for deposits ability to add manual checks reconciles BCBS billings Interfaces to General Ledger Module. General Ledger Module Produces the accounting entries for the company.  Key features of this module are: multiple company, locations double entry bookkeeping manual journal entries to reclassify general ledger information trial balance detailed general ledger identifies source of entry journal listing general ledger report writer Call Center Software Our call center software provides a common point to access employee information and keeps a record of the questions and answers so they are available to anyone in the office.   Information that is available through the Contact Log screen is: Healthcare maximums Medical claim history Contact history    Web Interface Our web interface provides the employees and health care service providers web access to the Claims Management System. The web interface allows the employees to: Check the status and view the history of their medical claims Service providers can use the web interface to: Check employees eligibility in the health plan  Check the status and view the history of their medical claims