The Enterprise System Vision Suite is designed to meet the needs of vision benefit administrators in organizations of all sizes. With our flexible, customizable benefit plan development feature, you can design, develop and launch new products quickly. To meet the highly specialized needs of the vision marketplace, the suite features a unique Provider Web Portal for claims and prescription management and automated ordering and fulfillment of vision materials.
The Enterprise System Vision Suite comes preconfigured with vision-specific terminology, procedure codes, business rules, real-time dashboards, and on-demand reports, all based on vision industry best practices. The Vision Suite offers a comprehensive set of administrative functions, including:
- Enrollment and eligibility
- Fee schedule management
- Flexible reimbursement methods
- Benefit plan design and maintenance
- Claim data entry
- Claim editing, adjudication and payment
- Customer service
- Provider network management
- Premium billing
Choose From a Full Spectrum of Features
With the Enterprise System Vision Suite, you can continue to use the features in your existing system that work well for you. Choose the Vision Suite functionality that you need, and we will work with you to integrate seamlessly with your existing system.
Self-service portals offer easy access to real-time data drawn directly from the Enterprise System, making it quick, easy and inexpensive for payers, providers and members to get the information they need, when they need it.
The Enterprise System Vision Suite features a unique web-based order generation portal which allows providers to verify specific patient benefits, submit claims for eye exams, enter prescription information, and order vision materials – such as eye glasses and contact lenses – for members at the point of purchase. The system can then transmit this information directly to a designated lab for fulfillment.
Real-time dashboards provide quick access to up-to-the-minute data as well as insight into trends over time. Use dashboards to analyze:
- Claim and authorization volumes, history, and trends
- Claim and authorization utilization statistics and summaries
- Enrollment statistics and trends
- Premium billing statistics and trends
- Provider reimbursement paid claim dollars and trends
- Provider/patient distributions
- Provider profiling
- IBNR calculations
- Benefit loss ratios and trends
- Self-funded account paid claim dollars and claim cost per subscriber summaries and trends
- Customer service call volumes
The Enterprise System is designed to support paperless workflows with its web-based architecture, built-in document management system, and fully integrated self-service web portals.
- Data file imports. The Enterprise System can import and process electronic data file loads in HIPAA-compliant version 5010 transaction set format and in its own proprietary file import format. Automated processing rules can be easily defined and managed through the user interface. And detailed Companion Guides and file format layouts are just a click away in the Online Help Reference Library.
- Integrated document management system. The integrated document management system can minimize or eliminate third-party document storage and retrieval fees. Electronic documents in nearly any standard file format can be attached and retrieved for instant online review throughout the system. For example, electronic health records and x-rays can be attached and included with a patient’s comprehensive claim history. Selected documents can be made available through self-service web portals.
Flexible Reimbursement Methods
The Vision Suite enables healthcare payers to leverage flexible reimbursement plans based on a variety of reimbursement methods and flexible calculation rules used to determine costs for each service performed.
Customizable Benefit Plans
Get products to market faster with the customizable benefit plan features built into the Enterprise System. Design a benefit plan once, duplicate it and modify as necessary, and override coverage options for specific employer groups. Select from features such as service limitations, exclusions, coverage rules, waiting periods, patient responsibility amounts and rules, multiple benefit levels, rollover benefit formulas, and alternate benefits, among many other options.