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Claims Adjudication
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
Download BrochureWhy 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
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."
NANCY GAREAUCEO of Ultimate Health Plans
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