Claims Adjudication

Our robust claims adjudication solution translates paper claims into digital records, processes electronic claims, maintains records and acts as an all-in-one payment reimbursement system.

Why our Claims Adjudication is preferred by Health Plans

Customized solution

Customized solution for easy integration and handling

Minimal errors

Less errors as compared to manual intervention

Cost-efficient

Reduce administrative cost for pending claims

Improves turnaround time

Improves turnaround time for Providers, fast-tracking payments

Automated system

Automated medical, institutional and dental claims processing system

Why our Claims Adjudication is preferred by Health Plans

Customized solution

Customized solution for easy integration and handling

Minimal errors

Less errors as compared to manual intervention

Cost-efficient

Reduce administrative cost for pending claims

Improves turnaround time

Improves turnaround time for Providers, fast-tracking payments

Automated system

Automated medical, institutional and dental claims processing system

Features at a glance

Account Management

View AR Ledger of client

View Claims

○View Claims Details

○View Service Details

○View Provider Details

○View Edits

○View Documents

○View Notes

○View MOOP

○View Activity Logger

○Prior authorization from Utilization Management

○Pricing details

○Member details

○Claims Movement

Global

○Global Search basis claim number, patient number, NPI etc

○Dashboard shows the breakup of claims into Professional, Institutional, and Dental buckets

○Claims Assignment to

File Management

○Files

○Upload files

○Great Plains

○Encounter Files

Queue Management

Following queues are available: Pending , On hold, Payer review, Management review, Approved, Denied, Pre batch, Batch to pay, Paid and Draft. Categories are:

○FFS professional

○CAP professional

○FFS Institutional

○CAP Institutional

○Dental

Reports

○SSRS reports/Power BI reports

○Scheduled reports

Check Management

○Check void

○Check reissue

○Check refund

Member Management

○Search Member

○MOOP Ledger

○Prior authorization

Letters

○Explanation of benefits(EOB) generation

○Explanation of payments(EOP) generation

○Rejected letters generation

○IDN letters

○Over Payment Letters

User Management

○Manage Users

○Manage Roles

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Why choose MIRRA's® Claims Adjudication?

Ideal for any type of plan (HMO, PPO, Dental, Vision, etc.). High auto-adjudication rate which improves timeliness and quality of claims processing. Flexible configuration rules that will allow any benefits to be processed with a high auto-adjudication rate. Built in automatic quality checks such as high dollar reviews

Our futuristic and affordable products, ClaimsLite® and ClaiMaster® can be integrated easily with third-party gateways. ClaimsLite® is for the entry of the paper claims and ClaiMaster® is for the adjudication of the EDI claims mandated by the Centers for Medicare and Medicaid Services. Built in claims editing software with over 40 million edits including CMS NCCI edits. Editing software reviews claims for potential Fraud, Waste, or Abuse. Integrated pricers such as Inpatient, Outpatient, PDPM (Patient Driven Payment Model)

Reviews & Testimonials

DJ OLIVERExecutive Director of Liberty Medicare Advantage

"In the process of looking for a Third Party Administrator, we identified Mirra as a candidate. After meeting with the team and understanding their experience, systems, and processes, we knew we had a great partnership opportunity. Mirra was able to transition our data quickly and effectively. Our teams work very closely to ensure successful operations of the health plan."

NANCY GAREAUCEO of Ultimate Health Plans

"In 2021, Ultimate Health Plans (UHP) partnered with Mirra Health Care (Mirra) to develop a software platform to support processing Claims, Customer Service, Eligibility, Enrollment, Premium Billing, Encounter Processing and a Provider Portal for our Medicare Advantage Plans. Mirra collaborated well with our operations and compliance teams to successfully design and implement a system that was innovative, efficient, and compliant with all Medicare and Florida Medicaid guidelines and requirements all within the scope of our required timeline. We greatly benefitted from the Mirra Project Management Team’s regular communication with Stakeholders through monthly meetings and recurring weekly breakout-focused calls, which were geared towards troubleshooting and goal alignment. Mirra was able to quickly maneuver and adapt their systems to our needs, resulting in successful implementation and go-live. Mirra continues to support our compliant operation and growth in the ever-changing healthcare industry rapidly and effectively updating their systems with new Medicare and Florida Medicaid rates and guidelines to ensure seamless compliance and efficiency. I have absolutely no reservation in recommending their systems to any Payer searching for improvement in their operational efficiency."

DJ OLIVERExecutive Director of Liberty Medicare Advantage

NANCY GAREAUCEO of Ultimate Health Plans

DJ OLIVERExecutive Director of Liberty Medicare Advantage

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