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CAP Solutions…The Key to Your Professional Claims Assistance Practice
Developed for the claims assistance community by a working professional, CAP Solutions lets you efficiently and effectively manage claims for your clients. This encrypted, smart client and web service based application supports multiple users, so you and your staff can manage your workflow from multiple computers at multiple locations. There is no software to purchase or maintain, just a monthly use fee, and our onsite and offsite data backups ensure the safety and confidentiality of your sensitive data. All the information you need is only a click away. From the main screen, you select the clients to work with in response to phone calls and incoming paperwork. Sort by the column headings to quickly locate the claims you need.
Claims Assistance Professional has gone private and is no longer available to individual claims assistant professionals.
Figure 1. Main Screen Shot. Figure 1. The Main screen showing the Client, Members and Claims areas.
After identifying the claims to focus on, you place them on a worklist, which again can be sorted as needed. Once you open an individual claim you have the ability to enter notes and data from EOBs, while viewing pertinent information about the member, provider and insurance plan. New claims are quickly and easily entered on the same screen, with look-up tables for providers, sites of service, types of service, CPT/HCPC codes and statuses.
Figure 2. Line Items Screen Shot. Figure 2. Showing the Line Items tab detail.
Figure 3. Notes Screen Shot. Figure 3. Showing the Notes tab detail.
Figure 4. Insurance Screen Shot. Figure 4. Showing the Insurance Info tab detail.
Figure 5. Member Screen Shot. Figure 5. Showing the Member Info tab detail.
Figure 6. ProviderScreen Shot. Figure 6. Showing the Provider Info tab detail.
Determining which claims need follow up is a breeze with the Claim Search dialog. Select the providers, clients and members you want to search for, or specify follow up dates, statuses or other information and all claims that meet the criteria will automatically appear on your worklist.
Figure 7. Claim Search Screen Shot. Figure7. Showing the Claim Search details.
Clients and associated family members are loaded into the Client File, so that you have details available on demand. Fields for key insurance coverage and benefits information (accessible when you view individual claims) help you swiftly determine if a claim has been processed correctly, while handy addresses and client notes keep you up to date.
Figure 8. Detailed Client Screen Shot. Figure 8. The detailed client info screen.
The Provider table lets you enter information on all types of practitioners and facilities, and includes an expandable field for notes on the office hours, staff names, etc. so you can efficiently work with providers to resolve claims issues.
Figure 9. Provider Screen Shot. Figure 8. The detailed provider list screen.
Finally, status reports for Open Claims, Closed Claims and Balances Due are available for your own use or for keeping clients updated and can be printed, exported or PDF’d for emailing.
Figure 10. Provider Screen Shot. Figure 9. Sample Status Report.
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25500 Hawthorne Blvd. Suite 1158   Torrance CA 90505
Phone 310 373 8363
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