LuminX is a fully automated claims adjudication system which combines integrated software design with the latest advanced technologies available in the computer industry. Although the design is global in scope, the user-defined system approach enables R H Administrators, Inc., to customize the system parameters to meet the requirements of our specialized client base. LuminX combines the functional responsibilities of
R H Administrators, Inc., operation by seamlessly integrating the areas of Claims Administration, Group Billing and Administration and Accounting. For a demonstration, please click on the icon.

Advanced Features & Benefits of the LuminX claims system include:

Expert System

LuminX contains an expert system module which automatically adjudicates all claims on a uniform, consistent basis exactly as the most experienced examiners do. The module performs many more checks to each claim than is feasible even for the most diligent claims examiner. The system can be prompted, on a step-by-step basis, to display the logic it uses to adjudicate claims. This allows examiners and claim representatives to be highly responsive to customer inquiries regarding specific claims.

 

Document Imaging

LuminX's integrated imaging technology transforms claims processing from a highly paper intensive activity to a truly paperless function. All claim related documents are electronically stored and can be retrieved at any time for video display or laser printing. Imaging eliminates the need for manual sorting, stamping, filing, and retrieval of documents.

 

Laser Form and Check Printing

All forms, including magnetically encoded checks and the Explanation of Benefits (EOB) are laser printed on stock paper. The system automatically prints checks with the required bank MICR numbers and required signatures depending on the specifications of the plan being administered by R H Administrators, Inc.

 

Comprehensive Database

Files have been designed to capture all relevant data pertaining to plans, groups, participants and providers. Files can be accessed for claims processing, utilization reports or plan modeling to access changes in benefits or assist in direct negotiations with providers.

 

Participant Tracking:

LuminX tracks historical claim activity for every plan participant, including images of all EOB's, correspondence and claims related documents, and a log of all phone calls related to claims activity. This feature allows users to instantly respond to telephone inquiries rather than sort through voluminous paper files.

 

"Claim Check"

Claim Check is a clinically intelligent expert system designed to audit and identify provider miscoding. It is estimated that as many as 30% of all providers codes result in costly overpayments. On average, 5-10% of all benefit dollars will be lost due to code gaming. Integrated into the R H Administrators, Inc., expert claim adjudication system, "Claim Check" accurately, uniformly, and consistently detects all major types of code manipulation and determines which medical procedures are appropriate for payment and which are not.

 

Reporting

LuminX provides comprehensive operational and management reports to measure and control the costs of the claims processing operation and the cost of the health care provided. The health care management reports, in particular, provide R H Administrators, Inc., with a tool for the measurement of a wide variety of cost containment strategies.

 

Integration of Systems

The LuminX system integrates claims processing with accounting group billing and administration, and management report. Billing accounting and management reporting databases are automatically updated from the claims processing systems.

 

Electronic Data Interface

LuminX system is designed to accept a variety of EDI formats and automatically import claims information into the system workflow.

 

Charges for R&C are verified on-line through the use of the MDR Database which automatically checks the charges for surgery, radiology, laboratory and office visits. Our MDR claims will be paid on the 90th percentile level.