Comprehensive Solutions
EnCore health benefit management solutions are delivered by an array of highly efficient and productive applications to manage and administer health, dental, vision and prescription drug benefits. These include enrollment, eligibility, billing, electronic claims, auto-adjudication, clinical editing, medical management, customer service, ad hoc reporting, standard reporting and a host of additional processing capabilities functioning in compliance with HIPAA mandated transaction code sets in a secure environment.

Our proven health care benefits administration system delivers accurate, highly automated healthcare transaction processing solutions to group health plans, third-party administrators insurance companies, self-funded associations, Taft-Hartley Plans and employers.

EnCore facilitates increased productivity, reduced costs, an improved customer focus and the ability to help your enterprise adapt quickly to new business opportunities.

 
Billing and Member Administration
  • Enrollment and eligibility
  • Premium Billing and allocation
  • Accounts Receivable
  • Sales Commissions
  • COBRA

Claims Processing
  • Benefit Plan Definition
  • Fee Schedules/Provider Management
  • Eligibility Determination
  • EDI Auto Adjudication and Workflow
  • Coordination of Benefits

Medical Management
  • Authorizations
  • Case Management
  • Concurrent Review

 

Dental Management
  • EDI Auto Adjudication and Workflow
  • Tooth Chart
  • Dental History by Tooth
  • Procedure driven processing
Reporting
  • Comprehensive set of Standard Reports
  • EnCore Report Builder - Ad hoc Reporting
  • EnCore Data Mart
System Overview Download

 

Optimized for Productivity
EnCore’s comprehensive benefit management solutions are optimized to deliver rapid and accurate processing of your administrative, claims and reporting processes.

Integrated Third Party software and services are offered as needed to further enhance the functionality and use of EnCore Systems. These include: printing and mailing of checks, EOBs and letters; scanning and imaging; data entry; usual and customary data bases; length of stay, clinical editing and unbundling data bases; HRA, HSA; Flexible spending; Cobra; Taft-Hartley; Data Warehouse.

 

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