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ELECTRONIC CLAIMS MANAGEMENT - EDI

RE-PRICING ADMINISTRATION


Since INETICO’s goal is to ensure that 100% of your claims are discounted, any claim that is not discounted through the primary network is often repriced through wrap and supplementary relationships. If no network is available, the INETICO negotiations analysts immediately contact the provider with an appropriately proposed rate adjustment. With signed provider approval, the analyst passes the discount back to the payor.

As part of the set-up process, the INETICO implementation team does extensive historical testing and evaluation of claims data to optimzed the resulting services and savings.   The first step of the evaluation involves geographic access analysis of the group and members for network identification.  Claims history analysis is performed to identify the best network discounts.  Best primary networks are identified down to the member level.  Network alternatives are compared to  greatest provider access vs. savings and vice versa Primary network recommendations established and logo’ed wrap networks suggested

To ensure repricing accuracy and speed, INETICO extends several claims submission options to our valued clients. EDI (Electronic Data Interchange) is the most preferred method. INETICO offers on-line web-based repricing and paper submission options to clients with alternative needs.

INETIPASS

INETIPASS is INETICO's proprietary web software solution that provides proper routing of each claim to the INETICO contracted networks and also coordinates the  daily efforts of the INETICO claims negotiator.
Our clients can access the INETIPASS system via a secure web portal to access information such as cost savings, claim status, as well as, reporting data.

What makes INETIPASS Unique?

  • Multiple networks managed through one portal
  • Deep provider discounts averaging 20–50 % (depending on network and market)
  • 1st tier network coverage through negotiated discounts
  • Individualized network assignment by group and member
  • On-line claims repricing transparency through INETIPASS
  • Clinical data-mining and predictive modeling available to INETICARE users