As an Information, Technology, and BPO Service Provider, JMS offers a comprehensive line of administrative, professional, and technical services. Experience the advantages of higher profitability by utilizing our solutions. Administrative Services Our experienced teams are trained to effectively perform a variety of back office services to support the claim payment process. Online Data Entry Mailroom & Scanning Paper & EDI Claim Clearinghouse Member and Provider Maintenance Flex Processing Medical Enrollments Cobra Processing Provider Call Center Professional Services Subject Matter Experts comprise every aspect of our professional services to improve business workflow, business workflow consulting, and claim automation solutions. Plan Building Plan Auditing & Testing Auto Payment Improvement Examining Auditing Technical Services EDI Specialist, Developers and Claims Management Specialists are available to support any aspect of your system development. Claim Management System Consulting EDI Configuration Custom Programming and Software Development Cost Containment Products & Services IVR Fax Call Center Solution Medical and Dental Network Re-Pricing Out-of-Network Provider Contracting Electronic Provider EOB s and Payments
Administrative Services Our experienced teams are trained to effectively perform a variety of back office services to support the claim payment process. Online Data Entry Mailroom & Scanning Paper & EDI Claim Clearinghouse Member and Provider Maintenance Flex Processing Medical Enrollments Claim Examining Provider Call Center Online Data Entry Reduces backlogs quickly with minimal setup JMS Operators can index claims, EOB s, and Re-pricing data directly into your adjudication software system. Mail Room & Scanning Providers can now submit paper claims to a JMS P.O. Box. All claims will be scanned into an electronic format and either hosted on a secured Paper & EDI Claim Clearinghouse Claim images will be converted to electronic format and combined with claims received through our clearinghouse partners. All claims will be will be formatted for easy entry directly into your adjudication system. Provider and Member Maintenance Improve auto adjudication rates. Updates are managed daily to keep your provider and member data current and accurate. For example; updating NPI codes can support HIPAA compliance, or provider cleanup services to identify and flag duplicate records. Flex Processing and Medical Enrollments Stabilize the workflow during seasonal peaks. Managing your seasonal Enrollment or Flex processing fluctuations are simple and under control by implementing our solutions. Claim Examining Reduce HR requirements and pay claims quicker. Our experienced examiners can quickly begin processing claims, perform maintenance tasks and more to meet or exceed your service level requirements and reduce backlog conditions by taking advantage of 24 hour resources. Provider Call Center Transitioning your provider calls to JMS allows your CSR s to focus on member calls. Our objective is to reduce call center CSR compliment by implementing technology solutions to handle most Provider inquiries - Claim Status, Eligibility, Authorizations, and more
Professional Services Subject Matter Experts comprise every aspect of our professional services to improve business workflow, claim payment accuracy, and claim automation. Plan Build Plan Audit Plan Test Schedule of Benefits Plan Build Experienced plan builders configure your system to maximize auto adjudication rates and reduce manual claim examining requirements. Schedule of Benefits Plan Audit To validate the benefit plan has been configured into the claims adjudication system properly, the JMS team performs a review of each Schedule of Benefits as it is represented in the system. Example of audited features: Audit tier accumulators, exceptions, non-covered service limits, dollar limits, etc. Review service codes build for each tier (in and out of network, out-of-area, etc. Verify Provider Networks are attached properly to each plan tier Schedule of Benefits Plan Test Utilizing claims testing templates (Client provided or JMS template or combination of both), scenarios are created to test the accuracy of the Schedule of Benefits configurations. A discrepancies report is provided to client for corrective action. Testing 100% of the benefits demonstrated on the schedule. Includes HCFA and UB (Provider and Facility Services). Place of Service impact on benefit level is monitored. Review of deductible and out of pocket accumulation tracking. Adjudication process based on various benefit tier levels.
Technical Services EDI Specialist, Developers and Claims Management Specialists are available to support any aspect of your system development. Claim Management & System Consulting EDI Configuration Custom Software Development Our experienced Claims Management & EDI Specialist evaluate your current systems conditions and provide consultation services and software development support on all aspects of your claims system workflow. Claims Management & System Consulting Augment your management and IT staff by tapping into years of experience managing claims administrative functions, workflows, tasks, system configuration, coding, and claim error analysis. EDI Configuration & Custom Development Providing support with pre-load claim services and software development. Aggregating claims from multiple file formats to support inbound and outbound claim submissions. Conversion of Check Payment File, Check Register, and 837 to 835 format. Customized Claim Pre-Processing Systems 4010 to 5010 Two Way Conversions Converting Multiple File Formats
Wally did what every service provider wished they could he under promised and over delivered. David Jansen, VP Human Resources Karmanos Cancer Institute