QLAdmin Medicare Supplement Claims Auto-Adjudication

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QLAdmin Medicare Supplement insurance claims auto-adjudication is deployment ready with integration to third-party clearinghouses. All plans in all 50 states are supported for both Part A and Part B. Processing between 300 to 500 claims per minute, the adjudication engine runs 24/7 and continues to parse and queue incoming EDI files. Bring your business back in-house or get into this growing market.

Key Features

  • Claims processing dashboard with real time and historical adjudication data.
  • Business rules engine for benefit processing parameters for all plans in all states.
  • Automatic duplicate and eligibility checks.
  • Manual claims queue for exception processing and settlement.
  • Rate increase management for state filings, approvals, documentation, and implementation.
  • New business import utility for incoming Acord XML files.
  • Policy level history with before and after rate increase details and documents.

Key Benefits

  • Set processing rules and adjudication parameters without the need for programming or IT expertise.
  • Greatly reduce manual claims processing and increase efficiency and accuracy.
  • Increase timeliness and accuracy for implementing rate increases.



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