Background & Capabilities

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Background


Industry Demanding Change and Efficiency
The medical claims payment environment and its reimbursement models are undergoing dramatic changes due to government regulations, rising healthcare costs, complex social and economic issues and the dynamics within the delivery system. The majority of software now in use cannot meet the need for responsible and timely reimbursement processes acceptable to payors, providers and patients alike.  Most of this software is comprised of multiple layers of custom and packaged programs that create complex integration and data management issues. IT departments struggle as they attempt to eliminate fragmentation and keep pace with technology that continues to move at breakneck speed. Development of “smart” software processes that can accommodate both commercial plan models and government assisted models such as Medicare and Medicaid are well beyond the reach of most organizations, including many major managed care organizations within the industry. Many legacy systems now in use are over 25 years old, lack HIPAA compliance, EDI and E-commerce capability and can no longer adapt to the complex shared risk models now being formed among payors and providers. Health care business processes demand higher levels of integration to satisfy this complex decision-based information-dependent environment causing severe hardships for those organizations that fail to adapt.

Commitment
Responding to each client’s needs, personally and professionally, as if they were our own. We strive to distinguish ourselves in five key areas:

  • Product Quality

  • Professional Competence

  • Un-compromised Client Service

  • Industry Leadership

  • Technical Innovation

We seek to establish lasting relationships with our clients based on the value delivered through our products and services. We commit, in advance, to a mutually-determined course of action, confident that the end result will be more, not less, than we promised.

Integrated Solutions
Delivering end-to-end solutions that address a payor’s mission critical needs including claims entry and adjudication, coding compliance, group administration, billing and enrollments, HMO/PPO management, EDI, utilization management, HIPAA transaction compliance and provider contract management. The architecture puts complex functional processes easily together with knowledge-based processes and databases. Our solutions elevate our clients processes to new levels of sophistication that can spot physician overcharges and poor practice patterns. Our clients can now design, build and administer their health plans with processes that respond to the health care challenge all while containing costs.

Product Advancements
We provide stand-alone, Internet, and Application Service Provider (ASP) deployments of our advanced software solutions. Distributing technology and shared professional services through virtual private networks, leading to lower cost of information technology and improved performance of health plans.

W.O. Comstock & Associates fully connects providers, payors, employers and employees with an integrated processing infrastructure over the Internet. With extensive experience in developing integrated systems, our solutions give our clients easy access to integrated, valuable information and enterprise-wide functionality. Tailored to our clients’ requirements and providing real connectivity and integration to transform their legacy systems to operate in the new health care economy.

The company aligns itself with the overall trends of the industry, clearly realizing that it must take careful yet proactive steps toward developing new solutions that meet industry needs ahead of the needs of its clients.
 

Capabilities



  • SOFTWARE PRODUCTS
    Expert systems supporting all forms of integrated managed-care delivery systems.
    • Intelligent Claims Administration and Processing Systems (ICAPS)
    • Advanced Value Scale (AVS)
  • APPLICATION SERVICE PROVIDER
    Efficient deployment of technology coupled with expert professional services through the Internet and virtual private networks (VPN).
  • THIRD PARTY ADMIN SERVICES
    Complete claims administrative services for processing self-funded and partially self-funded benefit programs which support medical, dental, disability, prescription drug and dental.
  • FLEX ADMIN SERVICES
    Allowing health plans and payors to integrate flexible spending arrangements and Section 125 Plans within a central claims administration framework. Accommodates both manual entry and fully automated claims processing and payment through a variety of work flow options.
  • MEDICARE & MEDICAID EXPERTISE
    Experts in coding reimbursement and physician bill editing to conform to all current statutes and regulations from CMS and the National Correct Coding Initiative.
  • CONSULTING SERVICES
    A complete suite of management information technology services.
    • Complete Information System
    • Evaluations
    • TPA Audit
    • HIPAA exposure and assessment
    • Work Flow Analysis
    • System Analysis
    • Self-administration Transition Planning
  • IMAGING

  • Integrated imaging software allowing CAPS claim system to view scanned documents with the call of a function.  Provides quick and efficient retrieval of client and company documentation as well as providing a secure repository.
  • CLAIM REVIEW AND AUDITING
    We deploy expert systems for evaluating physician bills and reimbursement processes that conform to accepted national standards.
  • PROJECT MANAGEMENT
    Complete conversion planning and implementation.
    • On-site Training
    • Conversion Planning
    • Data Conversion Services
  • COST CONTAINMENT SERVICES
    Balanced cost containment solutions for health plans, employees, and providers.
  • RISK EVALUATIONS
    Develop fully-funded and partially-funded benefit designs, which allow for full integration of managed care cost containment programs.
  • FEE SCHEDULE DEVELOPMENT
    Complete fee schedule analysis and development for use in managed care arrangements.
  • RBRVS REIMBURSEMENT DESIGNS
    Conversion from UCR to RBRVS reimbursement processes for use in evaluating contract arrangements and for developing physician compensation plans.
  • CLAIMS RE-PRICING
    We can serve as the technology manager for provider groups to accommodate claims re-pricing and network administration.

  • BENEFIT PLAN DESIGN
    Review and analysis of current benefit plan designs and development of more cost-effective benefit programs.
 

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