ClaimSecure has a sophisticated extended health claims processing system.

Hospital Audits

In addition to adjudicating hospital claims to the plan sponsor’s plan design, ClaimSecure has developed prepayment audit programs to ensure that the hospital claims for the stay in a semi-private or private accommodation are valid for payment. In the prepayment audit programs, verification letters are sent to the member and/or the attending physician. Payments to hospitals are issued after the receipt of satisfactory responses from the member and / or physicians.

• Same Day Hospital Stay
• Long Acute Hospital Stay
• Private Room Charge

Claims are subjected to thorough examination, including plan parameter, usual and customary pricing and physician referrals. Coverage through various provincial programs is also taken into consideration.
Claims requiring special attention are referred to our Medical Consultant.

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