CAPS/2020 cuts your claims processing costs by taking advantage of state of the art processing features such as imaging and EDI. A completely interactive IBM AS/400® software package, CAPS/2020 facilitates the claims adjudication process and related functions of third party administrators (TPAs), insurance companies, and large employers.

CAPS/2020 integrates claims processing with full provider pricing and tracking, billing, COBRA, Direct Pay, Flexible Spending Accounts, Utilization Review and Trust Administration. It provides fully adjudicated online claims payment for medical, dental, vision, WDI, and fee claims, and generates government reporting such as 1099s, W2s, and HIPAA certificates. Its adjudication process can perform up to 500 different online edits, while checking eligibility and selecting the proper class of benefits.

CAPS/2020 has several interfaces developed with other products in the market that allow for:

• Online enrollment, benefit verification, and checking claims status through the Internet or a voice response unit
• Outsourcing of checks and EOBs
• Automatic claims editing such as unbundling, inappropriate diagnosis, multiple procedure reduction
• Checking COB against a national database