| Management Information Systems |
|
| La Cruz Azul decided to acquire the Power Managed Healthcare System (POWERMHS) product in response to the need of a new information system that could integrate all the functions realized by claims, enrollment, servicing, and finance areas. Also that could serve as support to other department's functions as providers and Governmental programs. |
- Count with an information system totally integrated.
- Create a file that maintains the history of our insured's contracts.
- Adjudicate claims
- Obtain precise information in utilization areas, providers and physician costs.
- Transmit information under HIPAA law regulation (universal standards)
|
 |
|
| CruzAzulEnroll is an innovative electronic enrollment solution that replaces traditional paper-based enrollment with easy-to-use and secure Internet-based software. For questions or more information about CruzAzulEnroll please call La Cruz Azul de Puerto Rico at 787-272-7800 |
 |
|
| La Cruz Azul de Puerto Rico, Inc, has incorporated this totally automatic system that verifies the coding of claims submitted by providers. This system adheres to the standards and protocols of the CPT manual, coding guides of CMS, HCPCS Level III and other references specializing in the medical field. With this system we assure ourselves to be paying correctly for services rendered and complying with HIPPA requirements. Along with Claim Check ® we offer Clear, Claim, Connection (C3). This new tool is for use by providers via the Internet. It gives providers access to: check policies & rules related to claim submission, explanations and relations of codes used via Claim Check ®, and the resources used to determine them.
|
|
|
| VIPS/STAR Sentinel is an electronic services tracking, analysis & reporting system. It was created to minimize the instances of fraud, abuse and misuse of services offered by La Cruz Azul de Puerto Rico, Inc. This program is a tool for the analysis of information directed to the detection of fraud, investigation, documentation & coordination of health services. It facilitates the functions of analysts and investigators by looking into: use trends, invoicing patterns, and deviation from statistical relations caused by fraud and abuse; it also focuses on the medical practices, uses & profiles of providers. |
|
|
|
|
|
|
