Core Claims Administration

The healthcare industry is addressing complex fundamental changes. Payers are finding that their core administrative systems lack the functionality, efficiency, and flexibility to meet evolving regulatory requirements and opportunities for growth in the market. An end-to-end program that compliments each customer’s pharmacy benefit manager (PBM) model is essential to provide control over the program, formulary decisions, rebate contracts, and provider relationships payers need to meet the demands of the rapidly evolving healthcare market.

New technologies are essential and highly flexible and powerful core administrative platforms are key. Argus offers an innovative solution that manages the complexity of pharmacy benefit management by streamlining processes, minimizing errors, and reducing research time.

Our core claims administration platform provides payers in all markets the flexibility, functionality, and automation required to meet changing market needs and drive new levels of administrative efficiency. The modular core administrative system delivers the flexibility to meet the processing requirements of virtually any health plan and enables payers to effectively reduce the risks, costs, and business disruption associated with core system conversion.

Our core claims solution provides flexibility through the variety of ways in which you can access your data—providing the control you need to make your program a success, including a single desktop application that allows the setup of any benefit or option, web services providing capabilities to process claims with pre-written interfaces, and mobile access to all data at all times.

We provide a real-time customer connection with any type of reporting tool from the client site to Argus, the ability to select a time to receive data for daily analysis, system-generated standard reports, and a new way to use tools to create interactive reports by adjusting pictures and graphs. Argus takes the complicated out of the process by getting data out to customers quickly.