Claims Management

With our collective experience and knowledge of healthcare delivery systems, Onicol has designed a revolutionary process for adjudicating claims. In fact, there is actually no need to file any claims. Onicol utilizes a claimless process with an emphasis on medical and pharmaceutical protocols and outcomes. We believe that, when implemented, our system seamlessly combines Medical, Pharmacy and Claims and allows the company to conduct exhaustive proof of loss and process all the necessary claim form information to populate HCFA 1500 data sets. The system is based on authorizing all services and collecting the completed outcomes for those approved services (essentially a complete Electronic Medical Record). Once a provider completes a service and enters the outcome for that service in the system, Onicol is able to immediately generate and adjudicate the claim and make payment — without the provider submitting a claim. We have established strict guidelines defining a clean claim (a claim that can be paid because there is no additional information necessary to pay the claim.) The Claims Management Team also educates providers and patients and provides 24/7 support to address claims questions, including the ability to track the status of a specific claim, EOB and COB information.

Clean claims are paid in a timely manner and generally in less time than regulatory requirements. The claims process may be extended under certain conditions, such as the need to obtain additional information, however, Onicol will proactively contact the claimant promptly to obtain the additional information. The result of our innovative claims management process is:

  • Outcome based payment — proof of loss insures paying for services actually rendered
  • Case rates — eliminate fee-for-service billing which is prone to high error rates, fraud and higher costs (both processing and payment)
  • Claimless system — Onicol systems will not require a claim to be filed by the patient or provider. If the approved service receives a completed clinical outcome then the Onicol system will automatically generate a claim for adjudication.
  • Pay-for-Performance — Onicol fully integrates reimbursement with Medical and Pharmacy utilization management, outcomes collection and process management
  • Provider satisfaction with less time spent filing and following up on claims, faster payment and a higher ratio of claims filed to claims paid