Medicare Supplement Claims Auto Adjudication

Manage all Medicare Supplement plans for Parts A and B across all states with ongoing claims processing. QLAdmin's distinctive system features facilitate effortless product and claims maintenance without interrupting your daily admin operations.

Automated Medicare Supplement Claims

QLAdmin provides comprehensive Medicare Supplement product and benefit management, claims file intake and processing, and policy lifecycle administration in one comprehensive system.


With QLAdmin's proprietary business rules engine, rate increase management tool, and claims processing dashboard, companies are empowered to maximize efficiency with their Medicare Supplement blocks of business without the need for custom programming.


Additionally, built-in Social Security and Day of Month billing calendars allow for better profitability management in this unique market. Real-time financial processing, automated system cycles, and quick product rate adjustments ensure easier policy management.


Contact us to schedule a demo to see how QLAdmin can benefit your business.

Medicare Supplement Products Supported

 

  • All Medicare Supplement plans
  • All states, including Wisconsin, Massachusetts, and Minnesota
  • All benefits, including coinsurance, excess amounts, and foreign travel

 

Key Auto-Adjudication Features

 

  • Claims engine dashboard with live processing metrics
  • Business rules engine to customize benefit and procedure code mapping
  • Duplicate claim and fraudulent provider analysis for waste prevention
  • Claims queue for pending review and one-click re-adjudication
  • Rate increase filing, documentation, and implementation management
  • Rate increase policy level exceptions allowed
  • New business and e-application import via ACORD file integration
  • EDI file integration with clearinghouse and EOB/payment vendors
  • Scheduled blackout times for system backup and maintenance

 

Fully Automated Claims Adjudication

Clearing house data file integration includes eligibility verification, duplicate claim checking, data scrubbing, and Explanation of Benefits and payment file creation.


Process Medicare Supplement claims continuously with no interruption to daily administrative tasks.

Diagram of QLAdmin Solutions Medicare Supplement Claims Auto-Adjudication Lifecycle and supportive tools.