Services
By focusing on client needs first, VestaCare is able to identify process enhancements that can be tailored to the specific issues of each client, benefit plan and operating infrastructure. In most every case the VestaCare team seeks a common opportunity to help the client capture, leverage and preserve the human knowledge inherent in their current manual based operations. With VestaCare’s expert system wizards, the client’s know-how is “learned” rapidly and becomes an integral part of continuing automation. System integration between a primary claims or billing system can be achieved in hours versus weeks and expanded to include many secondary systems, databases, tables or external systems and sources. For each business application applied to Claims payment operations, the associated elements of VestaCare’s solution matrix are identified:

Payors: Healthcare Services
("End-to-End Solutions for Perfecting Payment")

	Enrollment & Premium Billing Data Management	Claims Data Capture	Eligibility Test	PPO Routing & Repricing	Provider Match Logic	Auto-Claim Load & Auto Adjudication Optimization	Fraud & Out-of-Network Review	Automated Payment Management
	EDI knowledge of 834 format	Data Entry team	Plan member rules	EDI knowledge of 837 format	Customized rules for matching	Decision-making logic	Claim Adjustment rules	EDI knowledge of 835 format
	Data Accuracy Management repository	837 format data entry templates	Automated Smart Examiner	Transaction Router	Automated Smart Examiner	Automated Smart Examiner	Transaction Router	Transaction Router and Automated Payment tool
	Payor’s Claim and Billing system	Payor’s Claim system	Payor’s Claim system	Payor’s Claim system	Payor’s Claim system	Payor’s Claim system	Payor’s Claim system	Payor’s Claim system