Claims

Claims

The STEP Solutions Claim System has a flexible, rules based technology platform that fully automates claims and case management. This automation verifies a policy’s in- force status, verifies a claimant’s eligibility for benefits, calculates benefit amounts and generates documentation related to the claim in keeping with regulatory requirements.

STEP Solutions utilizes a unique strategy of gathering information from the Policy Administration System, Plan of Care, Service Lines, Product Definitions and Claim Rules to derive a precise claim amount calculation. Claims leakage can exceed 15% annually. STEP Solutions Claim System practically eliminates claim leakage. This fact alone justifies the purchase and delivers the ROI.

Long Term Care products contain a high level of complexity from a variety of benefit options that require a sophisticated method of payment calculation. The STEP System address Activities of Daily Living (ADL’s), Cognitive Impairment, Certification Periods, ICD9/10 Codes, follow-up activity reassessment and Provider information all in an industry standard JEE IT Platform.