EPOCH utilizes the industry leading TRIZETTO/RIMS claims system. This system allows for all the HIPAA requirements to ensure privacy and protection of PHI. EPOCH coordinates claim acquisition through several Electronic Data Interchange clearinghouses, and paper claims are scanned into our system using Optical Character Recognition (OCR) technology. EPOCH regularly auto-adjudicates claims with flexible plan designs that meet the requirements of our clients. We interface the system with state-of-the-art Internet tools which allow our clients to easily manage their enrollment and claim information. We have fully integrated applications for claims, eligibility, billing, COBRA/HIPAA, and customer service. EPOCH also reprices claims on behalf of a number of managed care networks.

Our approach integrates fully customized claims processing, web services, health management, customer service, and reporting. Further, our claims processing focuses on claim cost management through the use of:

      •  Subrogation identification
      •  System edits and triggers for LCM referral
      •  Out-of-network fee negotiation and settlement
      •  Fraud detection software
      •  Hospital audits