comprehensive line of administrative, professional, and technical services.
Experience the advantages of higher profitability by utilizing our solutions.
Administrative Services
Our experienced teams are trained to effectively perform a variety of
back
‐office services to support the claim payment process.
Online Data Entry
▪ Mailroom & Scanning ▪ Paper & EDI Claim
Clearinghouse ▪ Member and Provider Maintenance ▪ Flex Processing
Medical Enrollments ▪ Cobra Processing ▪ Provider Call Center
Professional Services
Subject Matter Experts comprise every aspect of our professional
services to improve business workflow, business workflow consulting,
and claim automation solutions.
Plan Building ▪ Plan Auditing & Testing ▪ Auto‐Payment Improvement
Examining
▪ Auditing
Technical Services
EDI Specialist, Developers and Claims Management Specialists are
available to support any aspect of your system development.
Claim Management ▪ System Consulting ▪ EDI Configuration
Custom Programming and Software Development
Cost Containment Products & Services
IVR Fax Call Center Solution
Medical and Dental Network Re-Pricing Out-of-Network Provider Contracting Electronic Provider EOB ‘s and Payments
Administrative Services
Our experienced teams are trained to effectively perform a variety of
back
‐office services to support the claim payment process.
Online Data Entry ▪ Mailroom & Scanning ▪ Paper & EDI Claim
Clearinghouse ▪ Member and Provider Maintenance ▪ Flex Processing
Medical Enrollments ▪ Claim Examining ▪ Provider Call Center
Online Data Entry– Reduces backlogs quickly
with minimal setup JMS Operators can index claims, EOB’s, and Re-pricing data directly into your adjudication software system.
Mail Room & Scanning – Providers can now
submit paper claims to a JMS P.O. Box . All claims will be scanned into an electronic format and either hosted on a secured
Paper & EDI Claim Clearinghouse –
Claim images will be converted to electronic format and combined with claims received through our clearinghouse partners. All claims will be will be formatted for easy entry directly into your adjudication system.
Provider and Member Maintenance –
Improve auto adjudication rates. Updates are managed daily to keep your provider and member data current and accurate. For example; updating NPI codes can support HIPAA compliance, or provider cleanup
services to identify and flag duplicate records.
Flex Processing and Medical Enrollments –
Stabilize the workflow during seasonal peaks. Managing your seasonal Enrollment or Flex processing fluctuations are simple and under control by implementing our solutions.
Claim Examining– Reduce HR requirements and
pay claims quicker. Our experienced examiners can quickly begin processing claims, perform maintenance tasks and more… to meet or exceed your service level requirements and reduce backlog conditions by taking advantage of 24 hour resources.
Provider Call Center – Transitioning your provider
calls to JMS allows your CSR’s to focus on member calls. Our objective is to reduce call center CSR compliment by implementing technology
solutions to handle most Provider inquiries -Claim Status, Eligibility, Authorizations, and more…
JMS has produced effective results for over 30 years. For more information call 877.489.8881
Professional Services
Subject Matter Experts comprise every aspect of our professional
services to improve business workflow, claim payment accuracy,
and claim automation.
Plan Build ▪ Plan Audit ▪ Plan Test
Schedule of Benefits Plan Build
Experienced plan builders configure your system to maximize auto adjudication rates and reduce manual claim examining requirements.
Schedule of Benefits Plan Audit
To validate the benefit plan has been configured into the claims adjudication system properly, the JMS team performs a review of each Schedule of Benefits as it is represented in the system. Example of audited features:
Audit tier accumulators, exceptions, non-covered service limits, dollar limits, etc. Review service codes build for each tier (in and out of network, out-of-area, etc. Verify Provider Networks are attached properly to each plan tier
Schedule of Benefits Plan Test
Utilizing claims testing templates (Client provided or JMS template or combination of both), scenarios are created to test the accuracy of the Schedule of Benefits configurations. A discrepancies report is provided to client for corrective action.
Testing 100% of the benefits demonstrated on the schedule. Includes HCFA and UB (Provider and Facility Services).
Place of Service impact on benefit level is monitored.
Review of deductible and out of pocket accumulation tracking. Adjudication process based on various benefit tier levels.
JMS has produced effective results for over 30 years. For more information call 877.489.8881
Visit us at www.jmsassoc.com
Our experienced Claims Management & EDI Specialist evaluate your current
systems conditions and provide consultation services and software development
support on all aspects of your claims system workflow.
Claims Management & System Consulting
Augment your management and IT staff by tapping into years of experience managing claims administrative functions, workflows, tasks, system configuration, coding, and claim error analysis.
EDI Configuration & Custom Development
Providing support with pre-load claim services and software development. Aggregating claims from multiple file formats to support inbound and outbound claim submissions.
Conversion of Check Payment File, Check Register, and 837 to 835 format. Customized Claim Pre-Processing Systems
4010 to 5010 Two Way Conversions Converting Multiple File Formats
Technical Services
EDI Specialist, Developers and Claims Management Specialists
are available to support any aspect of your system development.
Claim Management & System Consulting
▪ EDI Configuration
Custom Software Development
“Wally did what every service provider wished
they could…he under promised and over
delivered”. David Jansen, VP Human Resources
Karmanos Cancer Institute
