Unions & Self-Insured Funds
HPS provides comprehensive consultation, technology and software solutions for benefits administration of Health & Welfare Funds. Our solutions help to improve fund office performance by means of refined processes that are technology centered making fund administration fast, accurate and efficient. HPS products help Health & Welfare Funds perform a wide range of functions such as adjudication of hospital, medical and dental claims, EDI transactions, maintaining Master contracts, contribution accounting and eligibility, and administration of pension and annuity plans.
Our softwares are full featured, secure and very easy to use. Our softwares have the full range of features and go through a thorough security and compliance checks. Our softwares are fully certified as HIPAA compliant by Claredi (now Ingenix), a third-party organization that accredits entitites which send, receive or process HIPAA regulated electronic transactions.
Our flagship product, HPS NOVUS is currently utilized by self-insured health plans functioning under the Employer Retirement Income Security Act (ERISA), as well as by Third Party Administrators (TPAs). HPS has established a Clearinghouse for secure transmission of HIPAA compliant Electronic Data Interchange (EDI). HPS is committed to serving self-administered health plans and has been helping to provide electronic administrative solutions to union welfare funds for more than 20 years. HPS operates at the intersection of cutting-edge technology, strategy and intutive design. Also, HPS constantly keeps up with regulatory changes and upgrades its software to acheive complete compliance.
Finally, our exceptional high-performance software solutions are backed by passionate customer service.
HPS has never lost a client to competition. HPS partners with our clients to formulate a solution that best fits their current and future requirements. Our solutions are marked by inherent scalability and can be deployed without huge upfront capital expenditures. HPS solutions are designed to integrate easily with other software solutions. Most importantly, clients who want to assure themselves that they are fully compliant with HIPAA EDI turn to HPS, as our solutions are fully compliant. HPS has also serves as consultant for clients who require HIPAA security solutions, including disaster recovery.
HPS Novus is best suited for Self-insured and self-administered health plans. HPS Novus is a comprehensive software that incorporates Contribution Management including billing & receipt, Master Contract Maintenance, Eligibility & Cobra administration, Claim Processing (Medical, Hospital, Prescription Benefits, Vision, Dental, Hearing, etc.) and member and dependent administration. The system also has Pre-authorization module, Member service module, Utilization Module, Case Management and Disease Management capabilities. The system has capability to import electronic Claims and export electronic EOBs mandated under HIPAA. The system also has EDI capability for Eligibility query, Claim status query and Pre-authorization requests.
HPS Clearinghouse is the portal for payers and Providers for transmission of EDI. HPS Clearinghouse receives electronic files (both HIPAA compliant and proprietary) and transmits between Providers of service and Payers. HPS Clearinghouse is fully compliant for Confidentiality and Security in addition to being certified for EDI. The clearinghouse has extensive validation process to validate 4010 and 5010 transaction formats.
Employer Web Remittance
This is web-based software for employers to send the list of members every month to the Union or the Fund and remit the dues or contributions to the Fund. There is secure login available for each employer. The Fund can see all employer details. The database is synchronized with the HPS-TA.
HPS Member & Provide Online Portal
HPS can provide for Health Plans portal of entry for members to check their Eligibility and Claim status. HPS also provides forms on line for completion. This can include Member Registration form, Addition of a dependent etc.
HPS provides custom interfacing to other products, as desired by customers.
We help funds achieve compliance of HIPAA regulations. We do that by providing means for Electronic Data Interchange (EDI) and guidance for privacy and security compliance.