The Claims System - LuminX Claims System
LuminX is a fully automated claims adjudication system which combines integrated software design with the latest advanced technologies available in the computer industry. Although the design is global in scope, the user-defined system approach enables IDA to customize the functional responsibilities of IDA's operation by seamlessly integrating the areas of Claims Administration, Group Billing and Administration, and Accounting.
Advanced features and benefits of the LuminX Claims System include:
EXPERT SYSTEM
LuminX contains an expert system module which automatically adjudicates all claims on a uniform, consistent basis exactly as the most experienced examiners. The module performs many more checks on each claim than are feasible even for the most diligent claims examiner. The system can be prompted, on a step by step basis, to display the logic it uses to adjudicate claims. This allows examiners and claim representatives to be highly responsive to customer inquiries regarding specific claims.
DOCUMENT IMAGING
LuminX's integrated imaging technology transforms claims processing from a highly paper-intensive activity into a truly paperless function. All claim-related documents are electronically stored and can be retrieved at any time for video display or laser printing. Imaging eliminates the need for manual sorting, stamping, filing, and retrieval of documents.
LASER FORM AND CHECK PRINTING
All forms, including magnetically encoded checks and the Explanation of Benefits (EOB), are laser printed on stock paper. The system automatically prints checks with the required bank MICR numbers and required signatures, depending on the specifications of the IDA plan being administered.
COMPREHENSIVE DATABASE
Database files have been designed to capture all relevant data pertaining to plans, groups, participants and providers. Files can be accessed for claims processing, utilization reports or plan modeling to assess changes in benefits or assist in direct negotiations with providers.
PARTICIPANT TRACKING
LuminX tracks historical claim activity for every plan participant, including images of all EOBs, correspondence, and claims related documents, and a log of all phone calls related to claims activity. This feature allows users to instantly respond to telephone inquiries rather than sort through bulky paper files.
REPORTING
LuminX provides comprehensive operational and management reports to measure and control the costs of the claims processing operation and the cost of the health care provided. The health care management reports, in particular, provide IDA with a tool for the measurement of a wide variety of cost containment strategies.
INTERNET ACCESS PROGRAM
IDA has, in conjunction with its system vendor, developed Internet access to system information and the ability to perform certain online functions over the Internet. The technology being utilized is known as the IDA Information Network, which is powered by the "LuminX Web Server". We are pleased to make this powerful tool available to all of our clients. The IDA Information Network provides secure access to selected information over the Internet using a typical web browser. Available information will be
Chronology Inquiry - This will enable the user to obtain claim payment information along with the image of the EOB; a wonderful service tool that will allow participants to obtain claim payment information 24/7.
- Eligibility Inquiry and Update - Will allow the client to maintain eligibility, including additions and terminations over the internet in real time.
- Verification of Benefits - Allows any provider or participant immediate look-up to verify benefits.
- Client Billing Inquiry - Will allow the client to view its invoice and obtain either detail or summary information.
- Report Distribution - Will allow IDA to distribute reports via the web.
