Linnaeus, Inc.'s TheSys Healthcare Claims Processing and Auto Adjudication Software

THESYS^® Provides:
BENEFIT PLAN ADMINISTRATION Multi-Option Plans Fully Integrated with Claims and UM Accumulators, Exclusions and Limitations Co-pays, Deductible and Co-insurance MEMBERSHIP MANAGEMENT COB - Primary and Secondary Automatic Retroactive Enrollments and Disenrollments Profiles to control consistent Membership and PCP Changes ID Card Print Capabilities CLINICAL GUIDELINES Interfaced to Commercial Data Base PREMIUM BILLING Associations, Groups, Family, Individuals Multiple Billing Periods REPORTING Utilization Management Operations Ad Hoc Reports Encounter Data Practice Patterns Report Writer (via Crystal Reports)	REIMBURSEMENT MANAGEMENT Complex Reimbursement Methodologies Provider - RVU, Unique Patient, Fee for Service Facility - Per Diem, DRG, Discount Percentage Capitation Module - PMPM, PCP/Specialist, Age/Gender CLAIMS MANAGEMENT HCFA 1500, UB 92, Pharmacy Online Adjudication, EDI Capable Bundling, Unbundling and Global Compliance Very high auto adjudication rates CUSTOMER SERVICE Call Tracking Log and Track Modifications Comments and Documentation SECURITY Highly Flexible Multi-tiered User Controlled FINANCIAL MANAGEMENT Interfaces with Commercial Accounting Packages Broker / Agent Commissions Provider Check Generation 1099 Generation
MEMBER BANK ACCOUNT MANAGEMENT Authorize and pay claims from member-level accounts Real-time balance information includes optional Line-of-Credit Adjudication includes real-time balance calculation for accurate payment amounts Full TheSys provider/facility reimbursement suite or specialized discounts available UTILIZATION MANAGEMENT Fully Integrated with Claims Referrals / Authorizations Multiple Providers and Multiple Levels of Care Attached to One Authorization User-Defined Fields Automated Cost and Savings Calculations HIPAA EDI HIPAA Profiler allows users to setup and control EDI senders and receivers The HIPAA Import module manages all inbound transaction sets. One program; no confusion! Receive and process transactions directly from providers or through your clearinghouses CASE TRACKING Links Multiple Referrals and Authorizations Under One Unique Case Identifier Performs Automated Case Tracking by Diagnosis and Procedure Time Accounting PROVIDER MANAGEMENT Supports Multiple Plans with Multiple Reimbursement Arrangements Accommodates Multiple Practice Locations and Tax ID Numbers for Each Provider Calculates capitation Enrollment Online for a 24 Month Period per Provider