Paragon Benefits Revenue and Competitors

At Paragon Benefits, Inc., we have a dedicated staff of claims professionals who provide our client base with quality claims administration using leading-technology software and hardware. We have developed a process, which is highly efficient and has earned our organization a reputation as one of the best in the industry. This is evidenced by our growth and the retention of our clients from year to year. We are proud of our achievements and attribute our success to the attention we give to special needs of each client. Claims are received in our Mail Room where they are date-stamped and then imaged into batches. The batched claims are then routed to our Registration Area where they are entered into the AS400 System and given a Batch Number. This number is based on the received date and allow us to process the claims in the order in which they were received. During the Registration process, we verify the eligibility of the claimant, status of the provider, and the validity of procedure and diagnosis codes. All batched claims are immediately available online for inquiry by Customer Service and Claims Departments. Following Registration, the claims are forwarded to the appropriate Claims Examiner for processing. The AS400 System automatically edits several fields and conditions, including possibility of duplicate claims, pre-existing conditions, COB, eligibility, etc. If the system cannot completely validate the claim, the examiner receives a message for further research. If additional information is required, the claim is pended and the appropriate EOB or form letter is generated. Claims examiners are assigned a dollar-limit of claims payment based on their experience and level of training. Any claim processed in excess of the examiner's limit is automatically pended by the system for review by the Examiner's supervisor. Also, one out of every 20 claims processed by each Examiner is randomly selected by the system for supervisory audit. The claims auditor verifies all areas of claim processing including COB, pre-existing, eligibility, applicable plan benefits for the billed, reasonableness of procedure and diagnosis codes, etc. Any claim for which the payment exceeds $20,000 is suspended by the system and can only be released for payment by the Manager of the Claims Department. Checks, EOB's and system-generated letters are printed in the nightly production jobs. Cycles other than daily are appropriate for some clients, especially the smaller clients. After claims payment, our fully trained Customer Service Representatives are available to answer questions of plan participants or providers concerning the processing of claims, and are able to assist in resolving any concerns. After hours Paragon provides a 24-hour voice response system that gives the participants the access in benefits reporting. Paragon Benefits, Inc. will process all clean claims within 15 working days. Our internal goals require a procedural accuracy rate of not less than 97%. This covers such items as coding, appropriate payee, etc. Our Claims Department has a program of continuous training for all Examiners regardless of experience level. This contributes greatly to our high accuracy rate. As an added service (at additional charge) we can provide your data via dial-up modem connection into our processing system. This service would provide the capability to inquire into eligibility and claims history and status. The charge for this is the cost of the modem and any long distance charges incurred.