CMS Claims Department utilizes the EZ-Cap system to log, adjudicate, and pay claims. CMS is able to specifically customize an IPA's payment of a claim based on the Health Plan's contract, the Provider's contract, the member's eligibility, and the member's benefits. The system automates most of the processing to allow for greater accuracy and a faster claims turnaround time. CMS utilizes Macess to scan claims documents, store images of claims, and optically read the information for automatic loading into the EZ-Cap system. Macess also allows for automatic retrieval of claims that require more extensive research. CMS has the capability of receiving claims electronically through partnership with Office Ally, an electronic claims intermediary, for even faster claims turnaround time.
CMS also has a Claims Quality Control department that utilizes a claims auditing software by McKesson Claim Check. This ensures that claims are paid correctly and that a provider is not up-coding or unbundling claims to receive additional payment.