Claims editing features provide the ability to
integrate with third party edit tools as well as
integrated Medicare and proprietary rules to
perform bundling, unbundling, auditing and
Clinical Coding & Detection
DRG Grouper interfaces, and internal tools
to define and detect service and claim classifications
provide granular identification and control of health services.
Benefit Plan Adjudication
The process of adjudicating health claims is a
complex business ideally suited for automation,
and VISOVA provides a solution with simplicity
and power. Flexible Benefit Plan definitions allow
for great control over user defined Accumulators,
Copay, Coinsurance, Deductibles, Limits, and
If your business model requires that you manage
member enrollment, VISOVA has a fully integrated
enrollment system to support claims, premium billing,
capitation and all other member related activities.
The VISOVA provider system is designed to provide you
with the level of control you need for your business.