Physician Reimbursement

A reimbursing physicians, surgeons and hospitals application designed by Cal-SE Finance Solution

Product Overview

  • Developer Cal-SE
  • Type Financial
  • Platforms Web
  • Deployment Hosted (cloud-based)

The Maddy Emergency Medical Services Fund (SB12) is used to reimburse physicians, surgeons and hospitals for patients who do not pay for emergency medical services and for other emergency medical service purposes defined by existing legislation.

California Software Engineering (Cal-SE) has a proven Physician Reimbursement Program application that will address current issues with supporting Claims Processing application and slowness. Adding new required fields to detect eligibility of the claims. The overall goal of this phase is to improve user experience and enhance the accuracy of claiming process.

With Cal-SE web-based Physician Reimbursement platforms, SB12 team and vendors perform a wide range of functions, including submit claims (E-Form 1500 or 837 EDI format), Accounting will review and assigns doctor to random audit. Then make batch claims and process it for payment. Besides that, System will auto update warrant to database and generate RA report then send back to Vendor.

The application facilitates the distributed, decentralized decision making and planning process by supporting the nomadic nature of managers during the bidding and executing contract or payment activities.

Cal-SE Services Solution can be distributed and installed at remote offices quickly and easily. It can be fully deployed by any service organization with limited IT support even on a stand-alone PC. Cal-SE offers unparalleled ease of use and enables users to become immediately productive with minimum training

Cal-SE SB12 Service Solution includes modules:

  • Administration
    • Accounts management (Accounting/ Audit-Doctor/ Vendor/ Guest)
    • Code EOB, validation rules management with paid rate control
    • Medi-Cal patients management
    • Fund management
    • EDI (SFPT folders activities control)
    • Auto announcement with definable message templates
  • Vendors
    • Manual/ Electronic claim
    • Claims submission to SFPT folder or directly to application hosted on Gov-cloud
  • Claims/ Patients
    • Record history
    • Data Integrity – no duplication
  • Claiming Process (Accounting)
    • Claims (manually with 1500 form or auto EDI conversion)
    • Auto announcement of 997 form, RA payments
    • Audited doctor claim validation
    • Adjustment claims
    • Reimbursement

Key Benefits:

  • Intuitive user interface - seamlessly align planning, launching, and executing contract processes across your organization. It helps to increase the speed of fiscal tasks and staff leverage by automating its structural manual spreadsheet and legacy IT processes.
  • Flexible modeling design - with role-based fully customizable and its built-in financial intelligently spreading logic can quickly track various program, unit, department expenditure versus PO encumbrance.
  • Robust reporting - comprehensive and ad-hoc analysis with formatting and charting support can connect data across the organization.
  • Organization alignment and Centralization - aims to align the organization to a central contract, purchase order, and invoice in one place, providing a single version of the truth. Drill down across invoices and purchase orders to see the impact of the business's financial performance.