Claims Advantage™
for Group Health

Comprehensive bill adjudication for group health plans — proven to reduce employer costs by 25%. The ideal solution for self-insured groups of any size, with full HSA/HRA account tracking and seamless CDHP integration.

Group Health Claims Management

Comprehensive bill adjudication that reprices claims to any fee schedule or provider panel. Combines all the advantages of our proven workers' comp system with group health-specific features. Enables administrators to view all claims — workers' comp, STD/LTD, P&L and group health — on one unified system.

HSA/HRA Account Management

Automatically tracks HSA, HRA, and employer-defined trust accounts with virtual accounts to cover insured deductible components.

  • HSA Account Tracking
  • HRA Administration
  • Employer Trust Accounts
  • Virtual Deductible Accounts
  • Real-time Balance Updates

CDHP/High Deductible Plans

The final solution for Consumer Driven Health Plans — eliminates the usual medical provider and employer workflow of processing claims.

  • CDHP Administration
  • High Deductible Solutions
  • Employer-Defined Limits
  • Simplified Member Experience
  • Paperless Processing

Self-Insured Groups

Especially designed for self-insured employers of any size. Can cut employer costs by 25% through automation and efficiency.

  • Any Size Employer
  • 25% Cost Reduction
  • Employer-Defined Coverages
  • Custom Plan Designs
  • Stop-Loss Integration

Bill Adjudication & Repricing

Comprehensive bill adjudication reprices to any fee schedule or provider panel with clinical edits and PPO savings.

  • Any Fee Schedule
  • Provider Panel Integration
  • Clinical Edits
  • PPO Discount Application
  • Automatic Line Adjudication

STD/LTD Processing

Process Group Health alongside Short-Term and Long-Term Disability claims on the same unified platform.

  • Short-Term Disability
  • Long-Term Disability
  • Unified Claims View
  • Integrated Reporting
  • Cross-Claim Analytics

QuickPayNET® Integration

Combined with QuickPayNET® obtains substantial discounts from hospitals and providers with Point-of-Service adjudication.

  • Point-of-Service Adjudication
  • 5-7 Day Provider Payments
  • Hospital Discounts
  • One System for Banking & Claims
  • Member Portal Access

Medical Case Management

Integrated medical case management and utilization review — the same powerful tools used in workers' comp.

  • Utilization Review
  • Care Authorizations
  • Procedure Tracking
  • Cost Savings Analysis
  • URAC Support

Unified Claims Dashboard

Enables administrators to view all claims of an insured — workers' comp, STD/LTD, P&L, and group health — on one system.

  • All Claims One View
  • Cross-Product Reporting
  • Employer Dashboards
  • Member Portals
  • Instantaneous Reporting

Why Choose Claims Advantage™

Proven technology trusted by employers, TPAs, and MCOs nationwide.

99.999% Uptime

18+ years of continuous web-based operations with industry-leading reliability.

25% Cost Reduction

Proven to reduce claims processing costs through automation and efficiency.

IBM Business Partner

Enterprise-grade technology backed by IBM partnership and infrastructure.

HIPAA Compliant

Full compliance with healthcare privacy and security regulations.

Ready to Transform Your Claims Operations?

Join employers, TPAs, and MCOs nationwide who trust Claims Advantage™ for their group health claims management.

Schedule Your Demo Today