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Average Ratings 0 Ratings

Total
ease
features
design
support

No User Reviews. Be the first to provide a review:

Write a Review

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

WizWhy analyzes how the values of one data field are influenced by the values of other fields in the dataset. The analysis hinges on a dependent variable chosen by the user, while the remaining fields act as independent variables or conditions. This dependent variable can be examined in two ways: as a Boolean value or as a continuous measurement. Users have the ability to refine their analysis by setting various parameters, including the minimum probability for rule formation, the least number of instances required for each rule, and the comparative costs associated with false negatives versus false positives. WizWhy identifies and presents a series of rules that connect the dependent variable with other fields, expressing these rules using if-then and if-and-only-if constructs. Based on the identified rules, WizWhy highlights significant patterns, reveals unexpected rules that may indicate interesting phenomena, and points out unusual cases within the dataset. Additionally, WizWhy is capable of making predictions for new instances by leveraging the established rules.

API Access

Has API No 

API Access

Has API No 

Screenshots View All

Screenshots View All

No images available

Integrations

No details available.

Integrations

No details available.

Pricing Details

No price information available.
Free Trial No 
Free Version No 

Pricing Details

No price information available.
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 No 
Live Rep (24/7) No 
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 No 

Vendor Details

Company Name

Complete Health Systems

Website

completehealthsys.com/claims/

Vendor Details

Company Name

WizSoft

Founded

1983

Country

United States

Website

www.wizsoft.com/products/wizwhy/

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

Data Analysis

Data Discovery No 
Data Visualization No 
High Volume Processing No 
Predictive Analytics No 
Regression Analysis No 
Sentiment Analysis No 
Statistical Modeling No 
Text Analytics No 

Data Mining

Data Extraction No 
Data Visualization No 
Fraud Detection No 
Linked Data Management No 
Machine Learning No 
Predictive Modeling No 
Semantic Search No 
Statistical Analysis No 
Text Mining No 

Predictive Analytics

AI / Machine Learning No 
Benchmarking No 
Data Blending No 
Data Mining No 
Demand Forecasting No 
For Education No 
For Healthcare No 
Modeling & Simulation No 
Sentiment Analysis No 

Qualitative Data Analysis

Annotations No 
Collaboration No 
Data Visualization No 
Media Analytics No 
Mixed Methods Research No 
Multi-Language No 
Qualitative Comparative Analysis No 
Quantitative Content Analysis No 
Sentiment Analysis No 
Statistical Analysis No 
Text Analytics No 
User Research Analysis No 

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