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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.

Key Features

  • 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

Key Benefits

  • 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