How are customer service calls monitored and reviewed for accuracy?
• The Advantek Customer Service manager randomly monitors calls on a daily basis. Claims Processing System 13. Describe your adjudication system vendor and architecture. • LuminX is the software vendor supporting the Acclamation Systems, Inc. Luminx was founded in 1989. Luminx is an automated system designed for organizations entrusted with the responsibility of administering health and other employee benefits. 14. Describe your internal security controls for claim approval limits • Each staff member claims are fully audited and dollar limited until the accuracy level is approved by an auditor. The dollar limit is raised as the processor achieves mastery for their level of processing. In addition, access is initially restricted to processing only professional claims, (HCFA 1500) and later allowed hospital claims (UB-92) processing. • Advantek maintains separation of duty requirements (i.e., a person with payment authority cannot also have authority to alter eligibility.) Only the accou
