Claim Services

Here's how VBASoftware's Claim Services can help you:
  • Customizable Explanation Of Benefits (EOB) that can be hooked to Process Automation and delivered seamlessly to your members via Email or to VBAGateway
  • Customizable Remittance information for Providers with or without pended claims included that can be hooked to Process Automation and delivered via Email or to VBAGateway
  • Highly configurable reason code interface allowing for automated or manual pending/denial of claims based on user-defined criteria at many levels including Diagnosis, Procedure, Benefit, Plan, Provider, Subscriber/Member, Group/Division, Age, Place of Service and much more
  • Complex pricing capabilities through EDI repricing or provider setup allowing FFS, DRG, Per-Diem, Case Rates, custom pricing and more
  • Dynamic Quality and Audit module that takes user-defined criteria to generate audit processes that can then be used to populate results against that selection of claims, whether it is a specific number of claims or a percentage of the pool at random, for various types of audit errors (financial, data entry, etc.)
  • When EDI lets you down, user defined claims data entry allows the client to set a flow that matches their process in turn ensuring efficiency and accuracy
  • Utilize VBASoftware Notes module allowing the storage of any number of notes and documents per claim as well as create relevancy hooks to the corresponding data points (Member, Provider, Auth, etc.)
  • Tight integration with Reinsurance module assures that all claims traffic and member responsibility is reported to carriers without the need for external data collection or processes
Administer any type of claim with VBASoftware
Medical Claims

Industry leading claims processing capabilities that improve administrative throughput and accuracy!

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Dental Claims

Dental Claims functionality that includes tooth chart tracking, tooth/quadrant/arch based maximums and more!

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Vision Claims

Easily administer limits on lenses, frames, and exams as part of highly configurable auto-adjudication.

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Pharmacy Claims

Track everything your PBM sends you, including drug code information, refill details, brand indicators and more!

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Flex Claims

Maintain election balances, employer contribution and reimbursement schedules and hook to the card vendor of your choice!

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Life & Disability Claims

Manage all aspects of Life & Disability including tax calculations, W2 submissions, Policy & Forfeiture details and all relevant premium billing!

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Ready to learn more about VBASoftware? Download your free VBASoftware overview brochure.

See what VBASoftware can do for your business

VBASoftware is designed to allow you to administer any line of business your way. VBA offers unlimited flexibility and robust functionality utilizing the latest in cloud-based technology. Don’t sacrifice. Have it all with VBA Software.

Watch our video to learn more about VBASoftware