VISOVA allows you to configure logically ranked Client Products, Member Enrollment and Provider Pricing rules that will allow you to automatically control the life cycle of a claim. This process is performed every time a claim is analyzed for its next step in its life-cycle. We call this important process: "Net Select"
Net Select helps determine the rules that may apply to the claim:
- Duplicate detection methods
- Enrollment determination
- Pre-Certification and Referral restrictions
- PCP Involvement
- COB Rules
- Process method (PPO Re-pricing, Adjudicate Only, Re-Price and Adjudicate, Billing only, Access only)
- Rate and Payment controls
- Output determination
- Ranking and routing
- Out of Network handling
- Messaging
- User defined rules
- Filters
- Etc.,