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Claims Engine 2000

 Product description

CE2000 is a multi-user product that can run on almost any PC or PC network that supports Windows*. In addition to being able to create and transmit prescription drug claims quickly and easily,CE2000 supports several other  features that make it the product of choice for high volume or centralized claims processing environments.

CE2000 is LAN compatible allowing multiple users to create and transmit claims at the same time. Users can share a common database of plans and claims history making it easy to work from any station on the network. Shared files may be located on a Server or shared drive.

System Administrator functions provide for better management through the use of User IDs, passwords and privileges.

CE2000 offers an optional Claims Import feature that allows you to import your claim data from another system.

Our Real-time Import interface allows CE2000 to operate as a dedicated Transaction Client. In this mode CE2000 can immediately detect claims being imported from a host  system, convert them to NCPDP format, transmit them and return the response information to the host system, all in unattended mode.

And finally, CE2000 supports transmission using VPN, secure, encrypted internet transmission or VISA dialup. You can opt for transmission over the net using secure internet portal services.You can use an existing leased line or VPN connection to your switch, providing instant dedicated access. VISA dialup protocol is also available as either the primary means of communication or as a backup to a an Iinternet or VPN configuration.

* Windows is a trademark of microsoft Corporation

 General system requirements:

NOS:
Windows 2003 through 2012
Disk Space:
100 meg to install *
Client OS:
Windows 7 or higher
Memory:
512 meg or higher recommended
Disk space:
50 meg **
Printer:
Ink Jet, Laser ***
Comm:
Internet connection (preferred)
and/or 2400bps modem ***


This product is distributed on CD

*    Growth depends on options selected
**  Can be used with a network printer or no printer
*** A dial-up modem is not required if an Internet connection is used

 Switches supported

NCPDP claims are usually transmitted through a "Switch". The switch acts as a router to assure that the millions of claims being submitted by providers reach the correct payers and the responses from the payers make it back to the originating provider. The major national switches used with DayTech products are RelayHealth (formerly NDC) and Change Healthcare (formerly Envoy).

DayTech software is certified with both RelayHealth  and Change Healthcare for the creation and transmission of prescription drug claims in all of the commonly used NCPDP formats up to and including Version D.0.

 NCPDP versions supported

CE2000 currently supports the following NCPDP formats:

Version D.0 variable (all transaction types)
Version 5.1 variable (all transaction types)
Version 3.2 variable

 Protocols supported

CE2000 can transmit claims using a secure internet portal to either RelayHealth  or Change Healthcare . It also supports TCP/IP protocol which allows it to be used over an existing leased line or VPN. A dialup modem may be used as backup.

 Plans supported

CE2000 comes with setup information for over 2,000 private and State Medicaid insurance plans that accept prescription drug claims in NCPDP format. This list is searchable by plan name, BIN, or processor control number. Once a plan is located it can be activated with a mouse-click and a few keystrokes. The plan is installed with its required fields already set. The user may fine-tune these fields as required to match their particular submission requirements.

 Single or batched claims

Normally POS claims are created and sent one-at-a-time in a manner that is similar to credit card authorization processing. Using CE2000 you may also create batches of claims and transmit them all at once. Batches may contain claims for different patients and plans. Users can create and delete their own batches as necessary. Claims may be created and added to the batch using the keyboard and screen or imported from a host system using the optional Claims Import feature.


 Claims import feature

Using the optional Claims Import feature, you can import claims to CE2000 from another system. CE2000 will convert the claims to the appropriate NCPDP format and save them in a batch. Once in the batch, claims may be edited, transmitted and erased as if they had been created using the keyboard and screen.

Import files may contain multiple claims for multiple patients and multiple plans. Each claim may exist in single or multiple records with fixed width or delimited fields. CE2000 contains a simple template system that allows you to map your import file format to the plans in your CE2000 system.

You can transmit batches of imported claims just like you would any other batch of claims. In addition to the normal printed reports and claims imaging functions, CE2000 will also produce a response file for each imported batch that may be used by the host system to determine the final status of each imported claim. This file both fixed width and delimited. Alternately, CE2000 can return both the claim and response in their actual NCPDP format.

CE2000 with the Claims Import feature and one workstation starts at $4,679.


 Real-time Import interface

Want to really automate your claims processing and still use your legacy system to create your claims? The CE2000 Real-time interface allows a PC to act as a Transaction Client. In this mode the PC continuously monitors a range of file names and launches an import operation any time a file name in the scanning range is detected. Files can contain single or multiple claims for single or multiple plans. CE2000 converts the claims to their corresponding NCPDP format(s) and transmits them using dial-up, leased line or frame relay. Response information is posted back to the originating system and the interface returns to idle mode waiting for the next import file. This all takes place using standard ASCII Sequential files that almost any system can create; no software integration is necessary!

Real-time mode supports several new options that allow it to be adapted to a wide variety of processing environments. It can be used for central billing batches, back-ending a practice management system for sending single claims as they are created, or for use by intake units that need to submit claims for preauthorization then immediately reverse them.

Best of all, CE2000 can be switched from manual to real-time mode with a single click of the mouse! CE2000 can also be configured to launch into real-time mode on system boot  

 Report Engine

The Report Engine is a feature of CE2000 that allows you to produce custom reports from a queriable database of information collected about each transaction. Refer to the Report Engine product description for details.  

 Local Reports

CE2000 also supports several local printing and report options that can be customized to your operation. It can print a full page for each transmitted claim which may then be placed in the patient's file. It can report the results of unattended batch transmission in several different formats from page-per-claim to line-per-claim and any combination thereof. A printed audit report may be produced at any time listing every paid claim. The report is organized by insurance plan with totals. Using the optional Import feature CE2000 can also return responses in files that can be parsed and processed by the host system that originated the claims.

 Claim statistics

CE2000 continuously captures payment information which is always available to management from the Claim Statistics area. This information may be presented on screen or printer using a variety of selection criteria.

 Claim images

The system may be optioned to save the latest image of every paid claim to disk. These claims are saved under the patient's ID and may be recalled at any time to reverse the claim or create a refill. They may also be used as a "boilerplate" to create new claims. This feature virtually eliminates data entry on reversals and refills. It also drastically reduces the data entry required on new claims. This feature may be disabled if you use the Import feature and want all claims to be submitted by a host.

 Point & Click design

Using the mouse and/or keyboard you can quickly navigate between screens and fields. Use a right mouse click to receive help on the purpose of the currently selected frame, box or button. Use a ? to receive help on the definition and code set for any data field.

 Help system

Help is always a mouse-click away! In addition to the printed System Administrator Guide, Quick Start Guide and Import Reference Guide, PDF versions of the manuals are always available from the program menu bar. You can even get help right down to the individual field level during claims entry that details the purpose of the field and the standard NCPDP codes that may be assigned to it.