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Core Administration and Claims Management Platform
Don’t waste time and money relying on manual and outdated claims management processes. Instead, unlock actionable insights and customized reporting with a digital and centralized claims management system.
Jalin Health platform is a trusted and time-tested core administration (benefits administration) and claims management engine. We empower domestic and international payer success through the solid technological foundation of our SQL-based platforms. Our platforms are engineered to drive higher rates of auto-adjudication and ignite growth and innovation across multiple lines of business.
Process claims on a familiar Windows interface with hot keys
Save time managing membership and eligibility, including individuals who are dually eligible for Medicare and Medicaid
Meet cost containment objectives by investing in affordable core administrative processing technology for the greatest ROI
Automate complex benefit calculations and drive high auto-adjudication rates with Jalin Health rules-based engine
Simplify regulatory compliance with HIPAA-ready EDI (Electronic Data Interchange), supporting ICD-10, CMS 1500, and UB04
Conduct Encounter Reporting in compliance with CMS and state Medicaid protocols
Automation of claim late payment penalty and interest calculation
Stay in control of the information that various users are authorized to view with Jalin Health smart portal solution
A full library of standard reports available for use and custom modification
Send automated, intelligent alerts to a variety of user-defined media devices including a cell phone or pager using Business Activity Monitoring (BAM) via Jalin Health Alerts™
Customize result/EOB codes and control their action (deny/pend/approve)
Proactively implement changes before they take effect using effective from and through dates
Generate and manage AP and AR transactions automatically or manually
Drive outcomes with an agile, dependable software solution based on flexible configuration capabilities
Invest in technology with the assurance of proven reusability to ensure success throughout ongoing healthcare policy and technology changes
Easy to configure, agile enough to address demanding business needs,
and flexible enough to capitalize on new growth opportunities, Jalin Health platforms deliver
Claims management, including claim auto-adjudication
Benefit administration
Robust member and eligibility management
Premium billing administration
Real-time claim editing
Reference data loaders that automatically load procedure/diagnosis codes, UB04, NCCI data, etc.
Intelligent alerts and reporting
Provider administration/referrals and authorizations
Capitation capabilities
Easy-to-manage multi-level security
Configurable add-ons, such as external Medicare grouper and pricer routines