Virtual Benefits Administrator is a comprehensive benefit administration system and claims processing software solution designed for health plans and benefit administrators.  Virtual Benefits Administrator is a rules-based software solution designed to administer complex benefits offering un-paralleled functionality and scalability with seamless, real-time integration with all system components.  Through continuous development in response to client requests and industry changes, Virtual Benefits Administrator provides a low cost of ownership easy to use system.  In addition to the integrated ancillary features the application includes:

• Thousands of built-in edits to verify and validate data in regards to eligibility, defined coverage's, plan maximums, benefit definitions, and accumulators particularly in relation to Medicare, Medicaid and Commercial Plans

• Accident (related to employment, auto accident, etc.) identification for purposes of cost containment and claims accuracy in reporting

• A myriad of pricing capabilities including FFS, Per-Diem, DRG, Provider Rate, Case Rate, Adjusted Discount, General Discount, etc.

• Ability to handle Coordination of Benefits (COB) at the claim level while using the Eligibility module to track the Primary insurance

• Allows for both Professional and UB-92 claims entry while tracking different data elements for each (i.e. Bill Type, Occurrence information, Patient Status on UB-92)

• Easily administer all brands of medical claims including Medicare, Medicaid or Commercial using complex or simple plans defined through the Plan/Benefit module