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
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
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