Claims Management Solutions.

Find the answers to your claims management search at CIMR at MS-HUG/Windows or MGMA. CIMR is one of the largest and most experienced claims processing companies in the world. They have scalable systems and software administering 15 million members, processing more than 90 million claims in healthcare benefits every year. CIMR's claims adjudication engine--Automated Medical Management System (AMMS)--might be the solution you're looking for. The processes within the AMMS system are integrated with membership and enrollment, pre-authorization processes, case management, nurse gatekeeper, etc. Determination of whether the patient is within the network or has obtained the appropriate approval for referral can be accomplished via a pre-claims transaction through the very system that generates the payment. The system provides specialized provider remittances that show multiple network or prompt payment discounts in varying electronic formats including standard electronic data interchange. The system also settles claims based on capitation, special provider payment schemes and adjusts payments to reflect out-of-network utilization. Cost containment features include sophisticated duplicate checks, coordination of benefits enhancements, Claim Check (re-bundling, unbundling) verification and medical protocol (OPTIMED) access within a managed care context. CIMR, Columbia, NC, www.cimr.com

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