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also allows the flow of information obtained from healthcare claims backto TecbC`ore'". The tin -site <br />clinical team will have real -time access to off -site provider information, which dramatically improves <br />continuity of Care. <br />Claims Administration <br />Our claims examiners work closely with your staff to support your facility. From claims processing to bill <br />payment, our Streamlined administrative services will provide you with valuable benefits. Each claim <br />received bythe claims department is reviewed for accuracy and adherence to community standards, <br />NaphCare assigns an authorization number to each off -slte occurrence that Includes a scenario detAhIng <br />the approved services integrated with service classes and procedural codes.. Only approved services are <br />reimbursed. We review claims to determine that charges are not! n excess of the approprlate Usual and <br />CustcmaryCharges, W also review claims for prior payment to prevent duplicate biIline. In addition, we <br />review for accuracy to Include vaIId dates of service, CPT and IG© -S codes, and bundling and unbundling <br />of codes Any claims that are not valid will be returned to the provider as -a denial and corrected claim <br />will be resubmitted for payment, The following criteria will be used In these revlews; <br />• Eligible Patients <br />• Usual andCwtomaryCharges <br />o Prior Payment <br />•. Accuracy <br />Services thatsupport our clients` efforts to stay current and compliant in dynamic environment <br />Include: <br />Uptinlie productivity for correctional facilities through automated essential operations <br />Identify correct payments for providers <br />• direct contracts with providers <br />• Flexible managed care software that allows for a wide range of date-sensitive feeschodules <br />associated with contracts, Including integrated DRG and APC processing <br />• Referral/authorization component to facilitate case management and utilization management <br />• Eligibility, submission /receipt of electronic claim files, and HIPAAstanrlards <br />• Customer service <br />• Facilitate daily transactions <br />• Allow providers to look up a member's eligibility and check claim status <br />• Provide clients a comprehensive, line -by -line bill audit and analysis, ensuring they are charged <br />a reasonable amount for the appropriate services <br />• Match facility and /or physician bills to itemized statements to identify errors and unbundling <br />of services <br />inmate Medical 5e *Q.5 <br />My of Santa Ana <br />25H -80 <br />UP No. 14 -034 <br />75 <br />} <br />a <br />r <br />