HOUSTON, Sept. 21 /PRNewswire/ -- EnCore System Professionals, Inc., a leading developer of medical claims processing software, today released its EnCoreBlue EDI management solution for Taft-Hartley health plans desiring to access the nationwide Blue Cross PPO network. The EnCoreBlue EDI (Electronic Data Interchange) tool enables these plans to efficiently tap into the Blue Cross network while significantly reducing claim turnaround time. The need to manage HIPAA EDI claims is virtually eliminated.
EnCoreBlue manages both inbound and outbound claim files. It includes code crosswalks, editing and validation features as well as reporting capabilities. Once claims are validated, they are routed through the plan’s core batch claims adjudication system and processed according to its benefit plan. Finalized claims are then routed back to Blue Cross for payment to their network providers. If the claim is designated as “fund-to-pay” the checks are produced by the Taft-Hartley fund office. All EOBs are produced by the fund office.
EnCoreBlue is a licensed EDI add-in solution module to EnCore’s claims processing system that can be applied to most Taft-Hartley plans without requiring technical resources. In most cases, no changes to the plan’s claims system are required.
“We believe EnCoreBlue is the cost-saving solution Taft-Hartley plans want. Our initial implementation is experiencing auto-adjudication rates of 68%, a 25% reduction of claim processing staff and a 24 hour claim turn-around time with no backlog. Savings attributed to Blue Cross PPO network access and the implementation of EnCoreBlue have exceeded one-million dollars per month,” said Don Baird, President of EnCore System Professionals, Inc.
EnCore System Professionals, Inc. is a leader in medical claims management and processing software for Taft-Hartley Plans and other self-funded healthcare plans.
For further information about the EnCore EnCoreBlue EDI Manager, you may contact Don Baird at 877-536-2673.
EnCore System Professionals, Inc.
CONTACT: Don Baird of EnCore System Professionals, Inc., voice,+1-877-536-2673, or fax, +1-281-368-7828, dbaird@encoresyspros.com
