HealthClaimPro™ is a breakthrough IPA split-risk claims automation system. This system is certain to save money and time while increasing efficiency and accuracy for claims processing organizations dealing with split-risk claims.

In a typical split-risk process, an associate must log on to an insurer's website and download claims in PDF or CSV format. The associate manually transcribes claim information to a back-end system for the review process. After adjudication, the associate must then log back on to the insurer's website and double enter the response.

This process is both time consuming and prone to errors. Byte Sized Solutions has developed an automated system eliminating nearly all user interaction. First, the web engine automatically downloads claim data from the insurer's secured website. The parsing engine then extracts data from PDFs or CSVs and stores claim information in an auditing database. HealthClaimPro™ then automatically adjudicates many of the claims and submits a response to the insurer. All other claims go through the systems integration engine which generates EDI 837 files which can be imported into your back-end system. HealthClaimPro™ then monitors and automatically replies to the insurer when an associate has worked the claim.