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Claims and benefits administration software. The system includes benefits enrollment, member management, billing, claims workflow and auto-adjudication allowing access to technology with low ongoing costs and efficient benefits plan administration.
- Complex Benefit Plan Configuration & Reimbursement Methodologies
- Comprehensive Benefits Plan, DOFR & Fee Schedule Configuration Options
- High Auto-Adjudication for Claims Processing
- Consumer-Driven Health Plans (CDHP/HRA/HSA)
- Powerful Online, Real-Time Claims Workflow Engine
- Integrated Medical Claims Editing & Code Bundling
- Extensive Provider Database Management Administration
- Integrated Document Management & BPO Services Available
- Fully Integrated Healthcare Information Technology Services
- Continually Upgraded Claims Processing & Admin Software
- Electronic EDI for Claims, Encounters, EOR, EOB & Eligibility Request &
- Response; HIPAA 5010 ready
- HCC and P4P Administration, Tracking & Reporting
- Data Integration to Vendors and HR Systems
- Comprehensive Provider Management Option
- Supports High Auto-Adjudication Rates
- Safe, Secure & Redundant Data Storage
- Customer Service Call Tracking Module
- Real-Time Reporting
- Scalable- Cloud-based architecture supports limitless expansion.
- Interoperable- Service-oriented design allows for unlimited interoperability and sophisticated collaboration.
- Modifiable- Tailor logic, workflow, and interfaces for unique strategies
SOLUTION OR SERVICE TYPE
Business Intelligence & Reporting Systems, Contact / Call Center Systems, Customer Onboarding Systems, Customer Relationship Management (CRM ) Systems, Custom Software Development Services, Health Claims and Case Management Systems (Medical, LTC, Disability), Insurance Agent / Broker Portal, Insurance Data Sets/Products, Insurance Fraud Detection and Risk Analytics Systems, Insurance Pricing Optimization Systems, Network Security, Operational Data Stores / Data Warehouses, Policy Administration and Servicing (PAS) Systems - Health / Major Medical, Real-Time Decision Engine (Insurance), Unstructured Data Analysis Tools