Experior's Coordinated Care Suite (CCS) integrates with all other systems for automatic transfer of patient encounter information and pharmacy claims, or to function as a stand-alone package with manual entry of claims processing.

The Coordinated Care Suite has over 170 on-line functions including:

• Accounts receivable management
• Maintenance of procedures
• Diagnoses
• Providers
• Contracts and schedules
• Pre-authorization and case management processing
• Claims adjudication and coverage plans
• Pre-existing conditions
• A free format for annotating records.

CCS also administers and maintains enrollment of groups and direct-pay subscribers.

CCS controls costs by monitoring referrals, membership eligibility, benefits, and utilization statistics. Statistics detailing plan profitability include comparisons between prepaid and fee-for-service populations. CCS processes variable benefit plans across multiple lines of business. And, real-time posting allows your staff to verify and process information quickly and accurately.

CCS has restricted access, with each operational function determined by password. This system restricts operators within their area of responsibility such as claims entry and inquiry.

Highlights of the Coordinated Care Suite include:

• Multiple HMO or financial entity flexibility
• Multi-level security and multiple lines of business
• Single entry of members with separate history of coverage changes
• Premium and retro billing capabilities
• Automatic or manual adjudication of claims
• Benefits administration by claim or individual service
• Pre-certification of inpatient stays, outpatient visits, referrals, home healthcare, nursing home stays, ambulance services, and durable medical equipment
• Control of provider services across all categories or by select groups
• Capitation processing with retro enrollment changes.

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