Average Ratings 0 Ratings
Average Ratings 0 Ratings
Description
Claims adjudication services cover a range of areas including medical, dental, vision, and prescription claims, as well as short and long-term disability cases. These services can be accessed either on-site with a license or through a hosted application model (ASP). Utilizing Microsoft technology, the system is powered by an SQLServer database paired with a Windows front end. Our customer service is highly regarded, staffed by healthcare claims professionals who boast a minimum of 12 years of industry experience. All support inquiries are recorded, and their statuses can be monitored online. The system features a plan copy and modification tool that facilitates rapid plan implementation. Auto-adjudication is achieved through benefit codes that are constructed using business rules derived from over 25 variables connected to both the claims and the claimants, which are then processed by the adjudication engine. Claims can be submitted in various formats, including scanned images, EDI, or paper submissions. The system is compliant with HIPAA EDI 5010 transaction sets, ensuring secure and efficient processing. Additionally, re-pricing fees and UCR schedules can be pre-loaded into the system prior to their effective dates, while the date-driven logic ensures that re-pricing occurs based on the service date, optimizing the claims processing workflow. The comprehensive nature of this system allows for a more streamlined and efficient claims management experience.
Description
Venue ™ Claims Management for Independent Adjusters offers a complete solution for overseeing the entire claims processing workflow. This system is suitable for various entities, including adjustment firms, third-party administrators, insurance carriers, and self-insured organizations. Users can enjoy a highly customizable interface, enabling significant self-modification of the claims management system to meet their specific needs. The platform includes a built-in web service interface, facilitating real-time or batch data imports, updates, and exports to nearly any external data-sharing source concerning all claim-related information. Furthermore, seamless integration with policy and billing systems ensures real-time synchronization of all policy-related details, which may encompass essential policy dates and alerts, such as ongoing fraud investigations and assumed policies. The system provides thorough capabilities for every dimension of claims processing—spanning claim payments, recovery processes, reserves tracking, contact management, trust accounts, forms templates, and extensive reporting functionalities. Overall, Venue ™ empowers organizations to enhance their claims management efficiency and effectiveness.
API Access
Has API
No
API Access
Has API
No
Integrations
No details available.
Integrations
No details available.
Pricing Details
No price information available.
Free Trial
No
Free Version
No
Pricing Details
$5 per month
Free Trial
No
Free Version
No
Deployment
Web-Based
Yes
On-Premises
No
iPhone App
No
iPad App
No
Android App
No
Windows
No
Mac
No
Linux
No
Chromebook
No
Deployment
Web-Based
Yes
On-Premises
No
iPhone App
No
iPad App
No
Android App
No
Windows
No
Mac
No
Linux
No
Chromebook
No
Customer Support
Business Hours
Yes
Live Rep (24/7)
No
Online Support
Yes
Customer Support
Business Hours
Yes
Live Rep (24/7)
Yes
Online Support
Yes
Types of Training
Training Docs
No
Webinars
No
Live Training (Online)
No
In Person
No
Types of Training
Training Docs
Yes
Webinars
No
Live Training (Online)
No
In Person
Yes
Vendor Details
Company Name
Complete Health Systems
Website
completehealthsys.com/claims/
Vendor Details
Company Name
KLJ Computer Solutions
Founded
1995
Country
Canada
Website
www.venueclaims.com
Product Features
Claims Processing
Adjustor Management
No
Case Management
No
Claim Resolution Tracking
No
Co-Pay & Deductible Tracking
No
Compliance Management
No
Customer Management
No
Electronic Claims
No
Forms Management
No
Paper-Based Claims
No
Payor Management
No
Policy Administration
No
Product Features
Claims Processing
Adjustor Management
Yes
Case Management
Yes
Claim Resolution Tracking
Yes
Co-Pay & Deductible Tracking
Yes
Compliance Management
No
Customer Management
Yes
Electronic Claims
Yes
Forms Management
Yes
Paper-Based Claims
No
Payor Management
Yes
Policy Administration
Yes