Eligibility and Third Party Liability

Ensuring healthcare dollars are paid by the right party on behalf of the right beneficiary is a critical function to healthcare program sustainability. CODICE verifies eligibility for program enrollment and benefits, and helps manages the coordination of benefits processed with third-party payers to ensure accurate payments.

Fraud and Abuse Control

From claims reviews to risk assessments, CODICE helps identify and investigate abnormalities, high-risk claims, and outlier trends, to reduce fraud, waste, and abuse on a pre-and post-payment basis.

Medicaid Claims Processing

CODICE has been serving Medicaid programs for nearly a decade. We understand the complex array of federal, state, and local regulations and requirements that aren’t necessary for accurate claims processing.

Patient Account Systems

CelerMed accounting system is singular to a given patient including invoices, billing, payments, claims documentation, and more.

Provider Credentialing

CODICE performs verification and validation of healthcare provider credentials for enrollment in commercial payer networks and government programs such as Medicaid, Medicare, Children’s Heath Capital Program, and others.

Application Development

CODICE offers fully customized software development services including drafting requirement documents, programming (.Net, Java, SQL, and all major platforms), testing, and bug fixes.

Customer Relationship Management (CRM)

CRM systems are only as good as their implementations and integrations with business processers. CODICE will facilitate a successful system launch by setting workflows, data processors, dashboards and reports, user inputs, and linkage to key systems.

Customer Service and Help Desk

Staffing for customer-facing positions is a key challenge for many organizations. CODICE provides experienced customer service and technical helpdesk representatives to get your service functions staff quickly. We provide fully outsourced departments or supplemental resources for exciting customer service teams.

Data Warehousing

CODICE provides development, implementation, and maintenance solutions for data warehouses that enable your organization to perform trend analyses, forecasting and budgeting analyses, performance reporting, risk and outlier identification, data integration, and other strategic business functions.

Enterprise Resource Planning (ERP)

Integrating enterprise data assets, business processors, and governance are challengers that requires specific expertise. CODICE provides planning, implementation, and monitoring solutions for content management, risk management, and functional systems linkage.

System Integrations

Getting sub-systems to function together as planned is our key expertise. Addressing both data synchronization and process integration, CODICE uses open source tools and APIs to ensure continued flexibility for your systems.

Customer Relationship Management (CRM)

CRM systems are only as good as there implementations and integrations with business processes. CODICE will facilitate a successful CRM system launch by setting up workflows, data processes, dashboards and reports, user inputs, and linkage to key systems.

Customer Service and Help Desk

Staffing for customer-facing positions is a key challenge for many organizations. CODICE provides experienced customer service and technical help desk representatives to get your service functions staffed quickly. We provide fully outsourced departments or supplemental resources for existing customer service teams.

Electronic Cost Reports

CODICE’s cloud-based software automates the cost reporting process and provides transparency, functionality, and compliance not available in manual systems.

Forensic Audits

Whether seeking to identify potential fraud, conflicts of interest, or financial statement errors, or just wanting deeper assurance of the accuracy of financial reports, CODICE provides clients with audit planning, investigation, reporting, and expert testimony.

Internal Controls

CODICE provides planning, implementation, and review/assessments of accounting and financial control procedures. Out experts will work with your financial, IT, and operational departments to ensure policies and procedures are in place employees are trained and operations/users are in compliance.

Rate Setting Methodologies

CODICE helps public and government agencies develop rate-setting methodologies using utilization data, risk assessments, and state-federal requirements.

Risk Management

CODICE provides a comprehensive risk management system and solution that has been used by numerous government agencies and corporations for over a decade. Contacts CODICE to learn more about our ICOSMOS systems solutions.