Mr. Microchip Software Center, Inc.

This is a complete system that ties into our Remittance Processing Module. It allows the self-administered Organization to process and adjudicate claims on-line.

Payments and Explanation of Benefits (EOB) to the Members and Providers are generated based on the criteria of the Benefit Plan. The system comes pre-loaded with 25000 Local Providers, 13000 Standard CPT Codes as well as 16000 ICD Codes. The system will check for Duplicate claims, Reasonable and customary charges as well as the Plan Limits and Caps.

• Employee / Dependent Maintenance Capability
• Provider Search / Maintenance during inputting of claims
• CPT Search / Maintenance during inputting of claims
• ICD Search / Maintenance during inputting of claims
• Testing for Member Eligibility based on the Plan Rules
• Testing for Dependent Eligibility based on DOS Testing for Duplicate Claims
• Comparison of U&R rates versus what was charged
• Testing for Multiple levels of Capping
• Design to handle COB
• User Designed Messages based on plan limits and rules
• Notes Capability on each claim to store relevant Information
• Pending Claims tracking system by Operator and by System
• Check Production using Laser Generated Checks
• Void / Manual check Processing ability
• 1099 Forms Generation with Magnetic Filing
• Management Production Reports and Exception Reports
• Check Registers
• EOB Letters