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| Data Entry Formats |
Standard HCFA 1500 and UB-92 |
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| System Integration |
Claims management organizations will like the feature that automatically links all medical bill review and payment transactions to the claim. Care Management Organizations will like the feature that enables users to search for an existing MBR patient record or create a new record “on-the-fly”. |
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| Turn Around Time Tracking |
Two received date fields enable incremental performance management, including payor and medical bill review unit turnaround times. |
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| Demographic Information |
Relevant data includes, client, insurance coverage, TPA, patient and employer information, insured information, and carrier information. |
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| Provider Information |
Relevant data includes name, numeric identification, contact information, specialty, PPO affiliations, credentialing, MCO certifications, and Provider Note Pad. |
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| Medical Authorizations |
Users can invoke the Case Status application to review patient specific treatment plans documented by the Nurse Case Manager and agreed to by the treating physician. Allegro also tracks and alerts users when pre-authorized treatment parameters have been exceeded during the bill review process. |
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| Medical Payment Reserves |
All transactions default to a Medical Reserve category, and the user selects from a client specific Payment Code table. |
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| Diagnostic Coding |
Up to four codes can be stored during each review. |
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| State of Jurisdiction |
All transactions default to a primary state, but the user can select an alternative jurisdiction and Fee Schedule when patients receive out-of-state care. |
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| Transaction Processing |
Medical procedure details include date-of-service, type and setting of service, procedure code, modifier code, units, charged amount, allowed amount, paid amount, state tax where applicable, explanation of benefit codes, and PPO discount. |
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| Medical Bill Rules |
A user definable rules engine automates many of the re-pricing decisions critical to optimizing medical benefits and medical loss costs, including follow-up days, procedures not related to patient condition or covered diagnosis, multiple procedure rules, modifier based reductions, procedures not related to provider specialty or medical authorization. |
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| Duplicate Services or Bills |
Allegro automatically alerts the user when duplicate dates, services or bills occur during processing. |
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| Explanation of Benefit
(EOB) |
Allegro enables clients to implement a standard or custom EOB including all pertinent patient, payor, provider and PPO demographic information, medical re-pricing details and explanations, ad hoc comment section provides additional payment information, statutory statements and references, and customer service contact information. The system supports the printing of a separate EOB, or a combination check and EOB dramatically reducing postage and handling costs. |
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| Provider Relations |
When the provider requests consideration for additional payment, Allegro enables the user to automatically create a new EOB and/or payment, generate the appropriate correspondence, and the financial status of the claim is automatically updated to reflect the additional medical payment. |
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| Letters and Forms |
Database merge fields interface with user definable templates automating critical medical cost management correspondence and forms. |
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| Billing and Invoices |
The Billing Gateway enables organizations to establish product specific billing arrangements for each employer or insured, including global fees for service, flat fee per claim or claim type, milestone billing, in addition to time and expense capturing. The system also accommodates state sales tax, automated claim expense allocations, and the ability to generate and reconcile client invoices. |
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