Best Core Administrative Processing Systems for Government

E-HAS serves as a comprehensive Online and Offline Hospital Administration and Management Information System tailored for healthcare organizations. This system boasts data warehousing and business intelligence features aimed at fostering sustainable growth within hospital operations while automating processes to reduce labor costs and enhance precision. Notably, E-HAS introduces a responsive design that is unprecedented in any Health Information System, along with support for mobile and tablet applications. Its architecture is versatile enough to accommodate various hospital types, whether specialty or general, and offers the capability to function online or offline, especially beneficial for networks of distributed hospitals. Furthermore, the data mining features empower healthcare professionals to make informed decisions. E-HAS stands out as a groundbreaking solution, encompassing a full suite of features that streamline hospital management, all while ensuring a rapid return on investment. This innovative approach not only enhances operational efficiency but also positions healthcare organizations for future success.

Create, enhance, sustain, and market your network all through a single integrated platform. Utilize competitive insights to bolster your market position effectively. Standardize and refine provider information to facilitate easier searches. Evaluate network performance using metrics related to accessibility, cost, and quality. Provide engaging and feature-rich solutions for provider searches. Gain a deeper understanding of your network's financial health. Construct and improve networks that are competitive, accessible, and provide high value to capture market share and fulfill the needs of your members. Monitor competitor movements and market prospects to sharpen your network strategy, pinpoint optimal providers to stay competitive, and convey the strengths of your network. Simplify your provider directory, plan design, and benefit consulting through quicker and more dependable provider network data. Design tailored networks that align with each client's specific objectives, risk tolerance, and desired provider access, ensuring a comprehensive approach to network management. This complete suite of features not only enhances operational efficiency but also strengthens your overall market presence.

A data-driven solution for managing claims and remittances specifically designed for healthcare providers looking to streamline their workflows, enhance resource efficiency, minimize denial rates, and expedite cash flow. Boost your initial claim acceptance rate significantly. Our all-inclusive edits package ensures you remain compliant with evolving payer guidelines and regulations. Increase your team's efficiency with user-friendly, exception-based workflows and automated procedures. Your personnel can conveniently utilize our adaptable, cloud-based platform from any device. Effectively manage your secondary claims volume through the automated creation of secondary claims and explanations of benefits (EOB) derived from the primary remittance advice. Leverage predictive artificial intelligence to identify and prioritize claims that require attention, allowing for quicker error resolution and minimizing denials before submission. Achieve a more efficient claims processing experience. Additionally, print and distribute primary paper claims, or compile and send collated claims along with EOBs for secondary submissions. This holistic approach not only enhances operational efficiency but also promotes better financial performance for healthcare providers.

PLEXIS offers a comprehensive suite of top-tier applications designed to equip payers with the advanced capabilities required for contemporary core administrative systems. These applications encompass functionalities such as real-time benefit management, adjudication, automated EDI transmission, and self-service customer portals, ensuring that PLEXIS Business Apps meet all your needs. The Passport feature facilitates crucial connections between core administration and claims management systems, PLEXIS business applications, custom applications, and existing internal systems. Its adaptable API layer allows for real-time integration with various portals, automated workflow tools, and business applications, ensuring that connectivity knows no bounds. By employing this centralized, modern core administration and claims management platform, you can enhance workflows effectively. This approach enables the efficient processing of claims while simplifying the complexities associated with benefit administration, resulting in a swift return on investment and the ability to provide exceptional customer service. Ultimately, PLEXIS empowers organizations to thrive in an increasingly complex healthcare landscape.

PlanXpand™ is the specialized transaction processing engine developed by Acero, which serves as the backbone for all products aimed at health benefits administrators. With this innovative engine, clients have the flexibility to implement Acero’s offerings either all at once or gradually over time. Beyond simply selecting from our standard range of products, administrators have the option to harness PlanXpand™ to create tailored solutions that enhance their current system functionalities. Acero’s distinctive, integrated solutions utilize a Service-Oriented Architecture, enabling health benefits administrators and insurers to augment their existing adjudication platforms with new features and capabilities. Furthermore, our advanced design and engineering facilitate real-time adjudication for all claim types, directly interacting with the core claims system, which leads to improved processing accuracy, increased customer satisfaction, and a reduced necessity for claims adjustments. This adaptability and precision in processing claims ultimately positions Acero as a leader in the health benefits administration sector.

The Amadeus Digital Care Record (DCR) offers a thorough solution that aims to give healthcare professionals a consolidated perspective of patient data right when it is needed. By merging information from various healthcare systems into a Health Information Exchange, the platform generates a comprehensive, up-to-date profile for every patient. This efficient methodology enhances clinical decision-making and boosts productivity, while also alleviating clinician fatigue by minimizing redundant tasks. Furthermore, the Amadeus DCR incorporates analytical tools and care coordination features, which play a crucial role in promoting improved patient outcomes by detecting risks at an early stage and facilitating effective care throughout the entire patient journey. Ultimately, this integrated system not only optimizes workflow but also fosters a more patient-centered approach in healthcare delivery.

Leveraging AI as a foundational strategy for payers, providers, and pharmacy benefit managers involves developing cloud-based products and platforms that enhance operational efficiency. A "healthcare digital platform" represents the amalgamation of various applications and cutting-edge technologies to deliver customized healthcare solutions that positively influence business results, marking a progressive and expedited shift away from traditional core administration processing systems (CAPS). To gain insights into how digital platforms and emerging technologies can help meet business goals, as well as their effects on healthcare payer key performance indicators (KPIs) and the overall appeal of these platforms, Infosys collaborated with HFS to survey 100 C-suite healthcare payer executives across the United States. This initiative aims to shed light on the evolving landscape of digital healthcare solutions and their potential for transforming industry practices.

Organizations in the life sciences sector, regardless of their size or complexity, depend on the ICyte platform to enhance pharmaceutical market entry and therapy commercialization processes. The ICyte platform equips biotech and pharmaceutical manufacturers with exceptional services that include the aggregation of channel and patient data, management of contracts and pricing, gross-to-net forecasting, and accrual systems, as well as expert solutions for launch and pricing transparency. By utilizing ICyte, both pharmaceutical and biotech firms can significantly enhance their market access capabilities by swiftly converting patient, payer, complex transaction, and channel data into practical insights. Additionally, ICyte offers analytics-as-a-service, facilitating the deployment of standardized models and metrics as a unified service across various applications, data streams, and analytical uses. The platform integrates key performance indicators (KPIs) tailored specifically for life sciences organizations. Furthermore, it features advanced analytics tools, including forecasting, scenario modeling, and a recommendation engine powered by machine learning, which aid companies in making data-driven decisions. Ultimately, ICyte is positioned as a comprehensive solution that not only simplifies processes but also empowers organizations to navigate the complexities of the pharmaceutical landscape effectively.

Veradigm Payerpath offers a comprehensive suite of revenue cycle management solutions designed to enhance financial performance for healthcare organizations by improving communications with both payers and patients, ultimately increasing practice profitability across various specialties and sizes. By addressing issues such as incomplete information, incorrect coding, and data entry mistakes, the system ensures that claims are submitted cleanly and accurately. It also guarantees that claims are correctly coded, devoid of missing details, and free from errors before submission. With advanced analytical reporting, practices can benchmark their performance against state, national, and specialty peers, enabling them to optimize productivity and boost financial outcomes. Additionally, Veradigm Payerpath helps remind patients about their appointments while confirming their insurance coverage and benefits, streamlining the process. The platform further automates the billing and collection of patient responsibilities, making it easier for practices to manage finances. Notably, Veradigm Payerpath's integrated solutions are agnostic to practice management systems, ensuring seamless compatibility with all major PM platforms, which enhances its versatility in various healthcare settings. This flexibility allows practices to focus more on patient care while efficiently managing their financial operations.

Our comprehensive platform provides fully integrated health plan solutions that add value and reduce the complexities of healthcare for employers, members, providers, and payers alike. Valenz combines member-focused services with insights derived from data, creating connections through personalized assistance that leads to high-quality care and enhanced outcomes. We prioritize early and frequent engagement through effective education, support, and services designed to prevent more severe and costly health issues down the line. By choosing Valenz, you can foster a healthier member population while consistently achieving cost savings for both plans and members year after year. To access the transparency and tools necessary for making quality-driven, cost-effective decisions, let’s discover your pathway to more efficient healthcare today. Additionally, the Valenz healthcare ecosystem optimization platform features a suite of fully customizable solutions that are all integrated within a single strategic framework, providing in-depth visualization of cost, quality, and utilization opportunities, ensuring you are equipped to navigate the healthcare landscape effectively.

Speed up payment processes while minimizing administrative tasks. With over 8,000 payer connections and established collaborations with more than 650 practice management vendors, our claims management solutions lead to a reduction in pending claims and decreased need for manual efforts. Efficiently and accurately send claims for various services, including professional, institutional, dental, and workers' compensation, ensuring prompt reimbursement. Tackle the evolving landscape of healthcare consumerism by delivering a smooth and transparent financial experience. Our patient engagement tools enable you to facilitate informed discussions around eligibility and financial obligations, while also lowering obstacles that could affect patient outcomes, ultimately fostering better healthcare experiences.

CORE unites various sectors of the industry to speed up automation and enhance business processes that simplify healthcare for patients, providers, and health plans alike. By leveraging the most reliable source of provider and member information, CAQH empowers healthcare organizations to cut expenses, enhance payment accuracy, and revolutionize their business operations. In the rapidly changing healthcare environment, ongoing advancements in payment and claims processing are crucial. Healthcare providers and health plans nationwide rely on CAQH to gather and oversee professional data, verify primary sources, and keep track of sanctions. Consequently, this leads to more efficient administration, improved regulatory compliance, and superior management of provider information. Ultimately, the collaboration fosters innovation and ensures that all stakeholders benefit from a more effective healthcare system.

QuickCap, developed by MedVision Solutions, is a comprehensive management tool designed to handle both administrative and clinical data processes, enabling users to prioritize their business operations instead of getting bogged down by paperwork. This solution offers scalable control over workflow and information, allowing for more efficient work practices. Users benefit from a customizable dashboard that enhances usability and automates processes for increased speed. Additionally, QuickCap simplifies claims handling, making the overall work experience smoother for users. Furthermore, it provides valuable analytics that assist users in easily assessing the profitability of individual providers. This combination of features ultimately empowers organizations to operate more effectively and make informed decisions.

As a company that emphasizes value-driven healthcare, effective communication through a versatile and scalable platform is essential for your success. NaviNet Open stands out as one of the premier collaboration platforms in the United States, enhancing engagement among providers and producing reliable, actionable insights throughout the healthcare delivery process. This secure multi-payer system not only improves communication but also boosts operational efficiency, reduces expenses, and heightens provider satisfaction. It enables real-time exchanges of crucial administrative, financial, and clinical data between payers and providers. For NantHealth, prioritizing security is paramount. Our adherence to HIPAA regulations, coupled with a steadfast commitment to our core values, has earned us EHNAC HNAP accreditation since 2006. Additionally, NaviNet Open holds HITRUST certification, demonstrating compliance with critical regulations and industry standards. This platform effectively mitigates risks associated with third-party privacy, security, and compliance, ensuring a robust framework for all users. Such dedication to security and efficiency fosters an environment of trust and collaboration in the healthcare ecosystem.

Achieve a significant edge over competitors with AxisCore™, utilizing cutting-edge and modular technology that enables effortless automation of your health plan administration. Bid farewell to the challenges posed by outdated core administrative processing systems (CAPS) and welcome our comprehensive solution. Designed with precision to enhance benefits administration, streamline healthcare claims processing, and improve overall management of health plans, AxisCore™ equips your organization to excel in the ever-evolving healthcare environment. With its user-friendly interface and robust features, AxisCore™ ensures that your team can focus on delivering exceptional care and service.

By optimizing and refining the processes involved in human capital management, you can gain complete oversight of costs associated with your workforce and ensure that your valuable human resources are utilized effectively. This allows you to conduct your daily operations with the confidence that your financial, statistical, and accounts receivable data is not only thorough and precise but is also seamlessly compiled and shared with authorized parties with little effort required. With access to a robust suite of integrated and e-commerce-enabled supply chain management software, you can take full command of the entire source-to-settlement process, significantly lowering workload and minimizing errors while enhancing efficiency, ultimately leading to a substantial positive effect on your overall financial performance. This transformative approach not only streamlines operations but also empowers your organization to respond swiftly to changes in the market, ensuring sustained growth and competitiveness.

HealthRules® Payer represents a cutting-edge core administrative processing system that offers transformative features for health plans across various types and sizes. For over a decade, health plans utilizing HealthRules Payer have effectively capitalized on market opportunities, maintaining a competitive edge. What sets HealthRules Payer apart from other core administrative solutions is its innovative application of the patented HealthRules Language™, which resembles English and introduces a groundbreaking methodology for configuration, claims management, and information transparency. This system empowers health plans by enabling them to expand, innovate, and outperform their peers more effectively than any other core system available today. As a result, HealthRules Payer not only streamlines operations but also fosters a culture of agility and responsiveness within health organizations.