Alternatives to ClaimPilot

APP Tech pioneered the incident-based approach to claims and risk management. Since 2003, we’ve delivered integrated technology solutions to hundreds of customers across North America — to improve claims-management efficiency and scalability, increase visibility, shorten response times, lower premiums, and prevent risk events. Cloud Claims by APP Tech is a top-rated risk management and claims software solution. IMS is a purpose-built software solution for self-insureds, TPAs, and companies who want to track their claims and losses. It helps users manage the entire claim lifecycle, from the initial incident report to issuing payments and collections. It offers a variety of features that allow users to have complete control over their claims, as well as risk information. These include incident management and claims management, workgroup tools as well as reporting, insurance tracking, and many other features. We’re proud of our 100 percent implementation-success rate and excellent customer-retention rate, a result of our commitment to understanding our clients’ needs and rolling out solutions that work for them.

AZZLY Rize is the premier clinical and business platform for addiction treatment and mental health organizations. As a modern technology platform, AZZLY Rize is a system that can scale with you. Use as little or as many of the features and functions available based on your program and staff needs. Key features for OUTPATIENT Programs include e-check-in, scheduling, appointment reminder, Zoom telehealth, treatment plans, progress notes, assessments and surveys. For RESIDENTIAL Programs: census, medication management, bed board, withdrawal management, DrFirst e-prescribing, EPCS, PDMP and labs. For all Programs: alerts, patient engagement, 5 star implementation and support services, and seamless electronic billing and claims submission. As a true all-in-one platform, we empower treatment centers to take control of their compliance and revenue cycle management and reporting requirements. As a purpose-built tool for mental health and substance use disorder programs, we offer a flexible pricing plan to replace dated technology. Use our compliant Master Library of Forms or we configure your documentation forms to match what you use today. Hosted in Microsoft Azure Private Cloud Network for added security and HIPAA privacy.

Speedy Claims was the top CMS-1500 software by providing the best customer care to our thousands of clients across America. Medical billing is not something people are excited about. It is a tedious task that you must do. Although it won't be an enjoyable task, it doesn’t have to be difficult or time-consuming. Speedy Claims CMS-1500 software makes it easy to complete the job quickly and efficiently, allowing you more time for the things that you love, such as helping patients. It's the best HCFA 1500 software on the market, with a simple interface and powerful features to eliminate repetitive work. It has powerful error checking built in to ensure that your HCFA 1500 form fills out correctly and is complete. This prevents CMS-1500 claims being denied.

Guidewire ClaimCenter stands out as a premier claims management platform aimed at optimizing the complete claims lifecycle for property and casualty (P&C) insurers. It encompasses a wide array of functionalities, spanning from the initial claim intake phase to final resolution, which empowers insurers to handle claims both swiftly and with precision. Among its notable features are automated workflows, integrated analytics, real-time performance tracking, and fraud detection capabilities, all of which work together to enhance operational effectiveness while boosting customer satisfaction levels. ClaimCenter caters to multiple insurance sectors, such as personal, commercial, and workers' compensation, and can be utilized independently or as a component of the Guidewire InsuranceSuite. By utilizing ClaimCenter, insurers not only expedite the claims process but also gain insights for informed decision-making and remain agile in response to shifting market conditions. Its implementation can lead to significant improvements in both efficiency and overall service delivery for insurers.

Virtual Examiner®, PCG Software’s flagship product, monitors an organization's internal claims process to track provider data for fraudulent or abusive billing patterns and maximizes financial recovery. The Virtual Examiner®, a PCG Software product, allows healthcare organizations to improve their claims adjudication system by allowing for more than 31,000,000 edits per claim. The software monitors an organization's internal claim process to identify and reduce payments for incorrect or erroneous code to save premium dollars. Virtual Examiner®, is more than a claims management solution that focuses on code combinations. It is a cost containment solution that evaluates the claim not only for abusive billing patterns but also identifies those claims that may involve third-party liability/coordination of benefits, case management opportunities, physician billing education and many other cost recovery reports.

Claims Manager is a complete, integrated RIMS system that streamlines your process from FNOL through settlement. Unique, configurable business rules engine automates workflow. It reduces duplicate and manual work, saves time, improves outcomes, and increases the value for all parties. Claims Manager's integrated solutions simplify workflow by allowing you to manage, adjust, and report on your property and casualty insurance claims. Claims Manager is an easy-to-use Risk Management Information System that provides tomorrow's solutions. Its intuitive interface seamlessly integrates into an automated workflow that can be accessed from any device, anytime, anywhere. It allows you to easily capture, benchmark and administer claims for all lines property and casualty insurance.

Duck Creek Claims offers a robust solution for managing the claims process, aimed at optimizing each stage of the lifecycle for insurance providers. It automates workflows from the first report through to the final settlement, while also simplifying data analysis via integrated analytics and ensuring compatibility with current systems. Notable features encompass advanced first notice of loss (FNOL) capabilities, automated assignments that consider adjuster expertise and current workloads, immediate access to policy and coverage information, and streamlined workflows for adjusters. This innovative platform significantly boosts operational efficiency and minimizes manual tasks, thus facilitating quicker claims resolutions and enhancing customer satisfaction, all while adhering to the latest regulatory standards. With its comprehensive tools and features, Duck Creek Claims positions insurers to effectively respond to the evolving demands of the insurance landscape.

With over 30 years’ experience, Hi-Tech Health has the expertise to service payers of all types and sizes, including TPAs, Carriers, Insurtech, Provider Sponsored Plans, and Medicare Advantage plans. Series 3000 is a cloud-based claims administration solution for businesses within the healthcare industry. No matter what your adjudication, reporting, or plan needs are, this platform reduces time processing claims and increases productivity as it assists with: •Client management •Benefits input •Electronic claim submissions •Claims processing With an implementation timeframe of 3-4 months, you can quickly get started with Series 3000. Our professional services and back office support teams are here to guide you through customization and training. With experts available at your fingertips, we’ll be able to support you so outside consultants won’t be needed. As your business grows, we’ll work with you to scale your software system to continue to meet your needs.

Introducing a cutting-edge and efficient method for managing and settling insurance claims. This comprehensive, all-in-one solution caters to various types of insurance, including property, liability, and workers’ compensation. ClaimRuler™ is a state-of-the-art cloud-based claims management platform crafted specifically for Independent Adjusters, Third-Party Administrators, CAT Adjusters, Insurance Carriers, Self-Insured entities, and Municipalities. The system facilitates seamless claims processing with integrated guided workflows, extensive reporting features, and an automated diary system that enhances the efficiency of the claims settlement process. Designed with the real-world needs of industry professionals in mind, ClaimRuler™ offers a user-friendly and functional interface, making it easier to manage forms, lists, documents, and images. Whether you are part of an I/A firm, a TPA, an insurance carrier, or a municipality, ClaimRuler™ is flexible and scalable to grow alongside your organization. This adaptability ensures that users can navigate the platform with ease while meeting the evolving demands of the insurance landscape.

ScanNStore is a compact yet comprehensive electronic document management and storage system designed to enhance productivity through effective organization of paper files. This innovative solution allows both you and your team to efficiently scan, categorize, store, and retrieve essential documents such as claims, attachments, and remittance notices. With its powerful search capabilities utilizing multiple indexes, ScanNStore presents claims and associated information on-screen, mimicking the experience of reviewing the original paper documents. When immediate access to crucial claim information is essential, ScanNStore proves to be the ideal choice. Reach out to us for a 30-day trial of our fully functional multi-user version, complete with options for volume seat licensing and vendor discounts. The system is compatible with an extensive range of TWAIN and production-level scanners, including models from HP, Fujitsu, Ricoh, Bell & Howell, and Panasonic, and also accommodates single or multi-page batch scanning, automated document feeding, and various adjustments such as page size and contrast. Additionally, ScanNStore's user-friendly interface simplifies the transition from paper to digital, ensuring that your team can start benefiting from its features right away.

FileTrac is the #1 claims management software in the industry. FileTrac Evolve builds on this reputation. This enhanced version is an integral part of the Evolve Suite - a comprehensive platform that revolutionizes your claims management process. FileTrac Evolve, a leading web based claims management system, is designed for independent adjusters and third-party administrators. It also works with managing general agents and insurance companies. FileTrac Evolve comes with a diary system that includes reminders. It also integrates with Quickbooks and Outlook, Xactanalysis and Symbility. Other key features include time tracking, expense tracking, invoices, adjuster timesheets and image and video uploads. Accounting reports, quick notes and more are also included.

IMPACT serves as the cornerstone of our comprehensive suite of healthcare administration software, designed to facilitate all aspects of health care data transactions. Users of IMPACT rely on it to handle enrollment processes, manage provider contracts and re-pricing, oversee benefit plans, and navigate authorizations and referrals, in addition to claims payments and the complexities that arise from these tasks. Offering remarkable flexibility, IMPACT comes equipped with a diverse range of features tailored specifically for the healthcare industry. The satisfaction and appreciation expressed by our clients bring us immense joy, highlighting the importance of our collaborative interactions and the software we provide that enhances their professional experiences. We believe that technology should prioritize the needs of the customer, which is why MCSI is dedicated to developing solutions that seamlessly integrate into our clients' enterprises, allowing them to adapt and thrive in their respective markets. Our wealth of experience encompasses all dimensions of healthcare data management and solution implementation, and we take great pride in crafting software that emphasizes automation, precision, and dependability, ensuring our clients’ success in an ever-evolving landscape. In this way, our commitment to innovation and excellence drives us to continually improve our offerings, aligning them with the dynamic demands of the healthcare sector.

CoreLogic revolutionizes the global property and casualty insurance sector by offering adaptable, collaborative, and secure technologies for claims estimation. We focus on delivering exceptional experiences that enhance business operations and positively impact lives. With Claims Connect™ from CoreLogic®, the claims process is streamlined for all stakeholders through a cohesive digital ecosystem. Transform your workflow to ensure that your customers’ claims are addressed with greater efficiency and precision. All relevant information is securely consolidated within a single platform, making it easily accessible to everyone involved in the claim. Say goodbye to the hassle of toggling between various software applications to modify and review claims data. You can create estimates or implement changes directly in Claims Connect, which immediately updates the information, ensuring that everyone has real-time access to the latest details. By keeping all participants in the claims process informed with timely information, you will facilitate simpler, quicker, and more effective resolutions to claims issues. This innovative approach not only improves operational efficiency but also enhances customer satisfaction throughout the claims experience.

An effective claims management software solution is designed to efficiently handle claims, complaints, and customer service inquiries. It facilitates rapid claims settlement, minimizes per-claim costs, and enables effective management of claim volumes through features like trend analysis, fraud detection, and insightful reporting. With cloud-based accessibility, it serves as a centralized hub for real-time information sharing and actionable insights. The integrated report generator allows users to create customized ad-hoc reports while providing advanced management information through heatmaps, dashboards, and trend assessments. Our system is built without limitations, ensuring seamless integration with any existing back-office solutions you may have. Utilizing Microsoft-based enterprise technology, it adapts to your business's growth and needs. Reduced onboarding time allows your team to start working efficiently from day one. Furthermore, it equips managers with automated, up-to-the-minute reporting capabilities. The platform also simplifies the integration process for legacy systems and accommodates various technological requirements. With expertise spanning multiple sectors, it enhances the ease of discovery, development, and integration for diverse business needs, ensuring a comprehensive solution for your organization.

FileHandler Enterprise helps TPAs, insurance carriers, public entities and self-insured organizations automate processes and improve efficiency. Our software keeps you on track with automation and customization, creating a standard claims management process for your business. From implementation to continuous, dedicated support through our Quality Assurance and Implementation Team Members, our goal is to deliver our client partners an effective business management tool, empowering them to automate workflows and increase productivity throughout their business cycle. FileHandler Enterprise allows businesses to facilitate integration with several third-party applications. We ensure that our software works well with preexisting systems in an essential part of our goal at JW Software; helping create customized third-party integrations for your preexisting ISOs, state systems, insurance systems, and much more. FileHandler Enterprise™ software will help you manage and close claims quickly, process payments to parties or vendors, and provide advanced reporting necessary to manage your business.

I-CAPS stands for Intelligent Claims Administration System, designed to comprehensively cover all aspects of the health claims payment sector through a unified architecture that meets the diverse requirements of payers, including areas such as membership management, billing, enrollment, mailroom operations, claims processing, network oversight, contracting, pricing strategies, utilization reviews, and customer support. Our I-CAPS, along with our Advanced Value Scale (AVS) coding compliance software, facilitates informed decision-making to assist clients in managing expenses effectively. The Advanced Network Administrator (ANA) ensures the accuracy of provider information in an efficient manner, while our Resource-Based, Usual Customary, and RESPONSIBLE fee schedule (RB-UCR) is a pioneering solution in the market, built on RBRVS and NCCI frameworks. For a thorough assessment of your plan or provider’s performance, consider utilizing our Cost Containment Audit and Recovery Services (CCARS), which provide a meticulous and non-intrusive evaluation of claims efficiency. This holistic approach not only enhances operational effectiveness but also promotes greater transparency within the health claims ecosystem.

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.

The vendor presents A1 Tracker as a robust and configurable risk management system that can be used standalone or in conjunction with other business segments within an organization. Risk Management & Threat Assessment: Register of risks to track risks at all levels within an organization. This includes entity, project, asset and contract, vendor, divisions, business units, regions, and more. Real-time risk reports and heat maps, dashboard metrics alerts & notifications. Contract Management Contract module to track all types of contracts with customers, vendors, employees, and customers. Claims & Incident Management Reporting on claims and incidents for any type of claim: injury, medical, customer, insurance or asset, liability, work comp, liability, etc. Certificates & Policies in Insurance: Policies & certificates for insurance tracking with reminders and renewals. For agencies & carriers policy management includes tracking clients.

CaseworksPro is a cost-effective online claims management system tailored to meet diverse claims processing needs. Created by Insurance Technology Solutions, this platform is specifically designed for the claims departments of insurance carriers, self-insured retentions (SIRs), and third-party administrators (TPAs). With its user-friendly interface, CaseworksPro incorporates a variety of functionalities, such as workflows centered around SIR clients, the ability to capture policy data, options for both one-off and scheduled payments, customizable user access permissions, check printing capabilities, electronic reporting features, and the ability to capture NCCI and ISO statistical codes. Additionally, its comprehensive approach ensures that all stakeholders can efficiently manage claims while maintaining compliance with regulatory standards. This makes CaseworksPro an invaluable tool in the claims administration landscape.

HM Health Solutions offers a comprehensive end-to-end solution designed specifically for health plans. With the Enterprise Health Solution, you can obtain the necessary support and achieve the desired business outcomes from a singular, integrated health plan administration platform. This suite of applications and tools oversees a wide range of functions, spanning from sales and enrollment to billing and claims, along with provider and clinical management, as well as customer service. The Enterprise Health Solution (EHS) stands out as the sole verified end-to-end solution that ensures a smooth transition for members from the enrollment stage all the way to claims payment. While other providers may assert that they deliver a fully integrated solution, they often fail to clarify that this may require the sequential purchase of multiple modules to realize true integration. In contrast, the Enterprise Health Solution maintains a singular focus on health plan administration, ensuring that our expertise in the payer space is unmatched. Consequently, when you choose EHS, you are opting for a platform that prioritizes your health plan’s unique needs and operational efficiency.

Find out why insurance adjusters and contractors choose our easy-to-use Estimating Software to Process Claims and Property Repair. Create estimates, sketches, digital pictures, reports, and other insurance forms, with minimal training. Never pay again for technical support calls. Our knowledgeable and friendly support representatives are available to help you. Simsol offers the most competitive rates, especially if you sign up for an entire year. ClaimsWire, a web-based software solution designed for insurance companies, allows for electronic assignment, tracking and exchange of data related to property claims. It integrates seamlessly into Simsol and supports all platforms for property estimation. It has powerful management and review features, built-in accounts, and more.

Startech Software’s TotalEclipse™ is a comprehensive Claims Management and Medical Bill Review Software application that operates on a single-database system. After more than three years of rigorous development and testing, this product has been crafted by actual claims adjusters, bill reviewers, and administrative managers who rely on this essential software in their daily operations. While many software developers prioritize user experience, TotalEclipse engages users directly in its development process. This collaborative effort results in an application tailored to real-world workflows, emphasizing easy access to the most frequently required information in the field. TotalEclipse is equipped with the advanced processing capabilities, functionality, and reporting features necessary to enhance productivity while effectively managing expenses. With a backend that supports scalability, it can be utilized on either the Microsoft SQL Server™ or Oracle™ platforms, making it versatile for various organizational needs. Additionally, the software's design reflects a commitment to continuous improvement based on user feedback, ensuring it evolves alongside the industries it serves.

Adjustify is an innovative video calling platform designed for professionals to engage with their clients for remote on-site inspections or in-home consultations. You can easily schedule a call with your client using the mobile app, facilitating a seamless digital connection. Throughout the video session, participants can utilize digital measurement tools and customer phone capabilities, such as zoom and flash, to capture an unlimited number of photos. Following the conversation, users have the ability to review a recorded video of the meeting and annotate the images taken. This cutting-edge video conferencing solution supports claims management across various sectors, ensuring essential continuity even during periods of social distancing. Amidst the challenges of remote work and social distancing, Adjustify provides a secure and efficient method for processing claims. By leveraging Advanced Video Calling technology, users can effectively connect with clients and perform on-site inspections from virtually any location, enhancing both productivity and client satisfaction.

Snapsheet makes claims simple. We do this through our suite of innovative insurance software solutions which transform insurance companies' ability to seamlessly manage claims, reduce cycle time, increase appraisal accuracy, and deliver payments effortlessly. We started it all with virtual appraisals, and followed that up with our leading claims management system. Today we are driving an industry-wide movement in claims by delivering solutions that enhance customer experiences while our customers create innovative, data-driven claims organizations.

W5 Claims Management Software - Streamlining your claims process while enhancing your business growth. Consider how many repetitive tasks you and your team handle daily; the cycle of doing this and that can become overwhelming. It’s not merely about reducing the time spent on these tasks, but also ensuring none are overlooked amidst a long list of urgent priorities. - Automation Involves dealing with a vast array of documents and images, which requires effective acquisition, organization, security, and distribution. This task is both substantial and essential for achieving success. - Document Management Meeting deadlines and adhering to customer service level agreements is crucial, but it's equally important to assess and report on your performance metrics. How effectively are your adjusters functioning? What obstacles hinder your team's efficiency? Can you provide evidence to your clients that their confidence in your services is well-founded? - Workflow + Business Intelligence Analytics can drive significant insights, ultimately leading to better decision-making and improved overall performance.

Our goal is digitization of data exchange between all claim handling participants: insurers and brokers, their customers and loss adjusters. Our platform allows you to account and share your cases or connect your claims system with our API hub to integrate with your partners. To exchange data with your partners, connect your claims system to the API hub. Direct integration of all claims systems cannot be achieved, so information must be exchanged manually. This slows down the process and increases costs. It also complicates claims process automation. ClaimsControl's purpose is to allow digital data exchange between all participants in the insurance claims handling process. Let's discuss any claims management solutions you may have. We can help you exchange data with other systems, or provide our users with your solution.

Claimable claims management software is designed for businesses to manage insurance claims. Reduce admin time and increase your claims handling capabilities. Stop searching shared folders or inboxes. All you need to access your claims data is a few clicks away Your data is safe and secure stored in the cloud. It is accessible from anywhere. No more paper! Prepare for an audit with a detailed history of each claim at hand. Keep track of all your documents so you can access them whenever you need. Filter and report on claims data to increase productivity and keep you informed. To organize and categorize your claims, label them. Keep detailed notes about each claim and share them with your team. You can quickly see which tasks are due and completed by assigning tasks to your team. You can quickly build and manage your contacts for claims and find contacts instantly.

Reduce expenses by managing claims with unmatched precision and effectiveness. Ventiv stands out as a top contender in the realms of risk management, insurance claims, and advanced analytics, serving over 500 clients worldwide and still growing. We support some of the largest brands globally with our leading-edge risk analytics solutions, ensuring they have the tools necessary to navigate complexities with confidence.

PwC's SMART (Systematic Monitoring and Review Technology) enhances both the efficiency and effectiveness of evaluating the quality of inpatient and outpatient coding processes while establishing a framework for quality assurance and compliance reviews. In conjunction with the support from PwC Health Information Advisory, SMART reinforces your strategy for monitoring coding accuracy and overall data quality. The SMART Inpatient module features over 1,000 established business rules designed to uncover potential coding errors and opportunities for documentation enhancement, with the option to tailor business rules to meet your specific needs. Comprehensive reporting and data analysis capabilities allow for the assessment of staff performance and the identification of educational needs in areas such as Coding, Clinical Documentation Improvement (CDI), Quality, and Providers. Additionally, the SMART Outpatient module boosts claim accuracy and highlights issues related to charge capture and workflow optimization. By mitigating the risks associated with inaccurate coding, it also fosters better regulatory compliance, ultimately benefiting the entire healthcare organization. Furthermore, the integration of these tools significantly streamlines the coding review process, ensuring higher standards of care and operational efficiency.

This solution provides a comprehensive claims management system from start to finish. Its main capabilities include processing claim adjudications, managing claim workflows, and facilitating payment distributions. With a versatile architecture, it allows for the integration of adjudication modules tailored to specific lines of business, ensuring that each new addition capitalizes on the system's core functionalities. The user-friendly interface, designed for Windows, leverages a relational database for efficient information storage. Built on the Powerbuilder software platform, it utilizes SQL databases like Oracle or Sybase, making it well-suited for a client-server environment that can handle significant claim volumes. Additionally, both installation and training services are offered, and the licensing package includes the source code. Furthermore, a team of experienced professionals is available to customize and adapt the system according to any unique client needs. All changes come with thorough design documentation and support for the acceptance testing process, guaranteeing a seamless integration experience. This ensures that clients receive a tailored solution that effectively addresses their specific requirements.

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.

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 FACTS® suite of products caters to various business sectors through a unified information system, including Health, Indemnity, TPA, PPO, HMO, PHO, IPA, MSO, Group Administration, COBRA, Section 125-Integrated Flexible Benefits, and Workers' Compensation with Integrated Managed Care, ensuring comprehensive 24-hour coverage. Since the establishment of HIPAA, the architecture of the FACTS® system has been rooted in solutions that adhere to HIPAA standards. Committed to facilitating a straightforward and efficient journey toward HIPAA compliance, FACTS® prioritizes readiness well in advance of the required federal deadlines. The fully integrated, interactive systems provided by FACTS®—accessible via the Internet and voice—equip healthcare professionals and administrators with around-the-clock access to vital claims and benefit information, in addition to enabling real-time transactions like EDI claim submissions online. By utilizing these tools, organizations can significantly enhance their risk management and insurance oversight capabilities. Furthermore, FACTS® remains dedicated to continuously improving its offerings to better serve its users.

The Risk Manager software leverages Microsoft SQL Server, enabling the development of tailored views and queries for effective reporting. Additionally, it supports ODBC-compliant applications, eliminating the need for reliance on ERIC Systems. The system is perpetually being improved, with updates being rolled out on a regular basis. Our approach to delivering these updates is straightforward: we provide new versions at no extra charge as part of the standard technical support agreement. Each user login is assigned specific dollar limits for check and reserve transactions, ensuring that any amounts exceeding these limits are subject to acknowledgment controls for total amounts paid to date and total incurred thresholds set at the enterprise level. Furthermore, our strategy for enhancing program features and standard reports is driven by the feedback and suggestions of our clients, ensuring that the software evolves to meet their needs effectively. This commitment to client collaboration ensures that the Risk Manager remains relevant and useful in a changing business environment.

Polygonal enhances previous versions' robust capabilities by integrating cutting-edge Microsoft VB.Net and Business Intelligence technologies, offering a holistic solution that swiftly adapts to today’s ever-changing market demands. This software is a modular, multi-currency platform for underwriting and policy/claims administration, seamlessly incorporating transactions, reinsurance, accounting, messaging, data warehouse reporting, document management, and workflow modules to deliver a comprehensive end-to-end business process with measurable outcomes. Developed with a focus on business needs by the expert team at City Computers, Polygonal benefits from years of experience in the insurance sector, combining practical insights with innovative solutions. As a result, users can expect not only efficiency but also enhanced decision-making capabilities through integrated analytics.

HEALTHsuite provides a comprehensive benefit management system and claims processing software solution for health plans that administer Medicare Advantage and Medicaid benefits. HEALTHsuite, a rules-based auto adjudication solution, automates all aspects of enrollment / eligibility and benefit administration, provider contracting / reimburse, premium billing, care management, claim adjudication, customer support, reporting, and more.

Effortlessly incorporate into current claims systems while streamlining automation and minimizing expenses. The dilemma of choosing between cost savings and enhancing customer satisfaction is now a thing of the past. Leverage data-driven insights for superior decision-making and automate tedious tasks to empower your claims staff. Prioritize your customers’ satisfaction by ensuring a smooth connection between incoming claims and your core insurance system. Address inefficiencies in processes through claims automation and witness a remarkable boost in customer contentment. By automating the handling of low to moderate complexity claims, you can significantly lower the incidence of manual intervention. Enhanced triaging and manual assignment of claims have led to a substantial increase in the effectiveness of case teams. The reduction in processing time for the remaining manual claims has enabled real-time settlements in numerous cases. The digital claims journey has been automated through the implementation of FNOL-completeness checks, coverage verifications, and automatic claims file generation, resulting in a more efficient system overall. This transformation not only improves operational efficiency but also cultivates a more robust relationship with clients.

Recordables offers advanced software solutions for managing liability claims, encompassing areas such as General Liability, Auto, Property, and various incidents. Their liability insurance tracking software streamlines the organization of incidents and claims associated with auto, property, and general liability policies. With TrackAbility, users can monitor all liability and risk incidents comprehensively, benefitting from a seamless process that handles injury liability claims from the initial incident to final resolution. The platform allows for the creation of customizable liability claim types based on user-defined criteria, enhancing flexibility and usability. Additionally, safety professionals and field personnel can work together on claims and reports, with the capability to continuously upload images and videos related to incidents or claims. Users gain a thorough perspective of the financial aspects vital for effective claims management, including payments and losses that can be analyzed by individual cases, specific locations, policy details, and other relevant information. This integrated approach not only improves efficiency but also fosters better collaboration and communication among stakeholders involved in the claims process.

There's no need to feel apprehensive about exploring new possibilities. This software is crafted to be user-friendly and adaptable to your needs. Your data is securely stored on cloud servers, ensuring safety and accessibility. You can simply visit the website on any device and log in—no installations are required. Worrying about updates is a thing of the past; we will consistently roll out updates to the website. With a shared custom database, everyone in your organization can access the same information. For instance, if you adjust the price of a commonly used item to align with local market rates, all employees will be able to utilize that updated item seamlessly. PowerClaim XML is a comprehensive, self-contained property adjusting software that streamlines the process of producing estimates, photo sheets, diagrams, and detailed reports. Additionally, the PowerITV Replacement Cost Calculator is a cloud-based tool designed to quickly and accurately determine the replacement cost of virtually any structure, utilizing up-to-date data from the Craftsman Book Company. This combination of software solutions enhances collaboration and efficiency across your team.

Mercury, developed by Quick Silver Systems, enables insurance providers in the Automobile, Property, and Casualty sectors to efficiently rate, quote, bind, process payments, and manage claims through an online platform. It reduces the volume of customer service inquiries by offering online access to documents, bill payments, and initial loss notifications. This API-driven modular system facilitates smooth integration with both new and existing data sources. The fully digital document generation and completely web-based platform ensure compatibility across all devices. Users can design tailored, event-driven workflows using our intuitive visual workflow designer. Stay informed with the latest data on Written, Earned, and Unearned premiums, while all pages, cards, reports, emails, and more are automatically saved for easy review and sharing with colleagues. Additionally, it supports currency collection in various digital formats, including ACH, EFT, electronic checks, credit cards, and bank cards. A robust information technology framework within an insurance organization must prioritize a system that not only ensures broad accessibility but also enhances operational efficiency. Furthermore, Mercury’s capabilities empower insurers to streamline processes, offering a competitive edge in the evolving insurance landscape.

TherapyNotes is a user-friendly, comprehensive practice management software tailored for professionals in the behavioral health field. It seamlessly incorporates advanced scheduling features, detailed patient notes, electronic billing options, and a personalized patient portal. Additionally, the software adheres to HIPAA and PCI compliance standards, ensuring that both practice and patient information remain secure and well-protected. The burdens of managing a practice often lead to excessive paperwork that can detract from patient interactions. With functionalities such as straightforward electronic claim submissions and facilitated ERA payment postings, users can expect to see a reduction in data entry mistakes and a decrease in monotonous paperwork. TherapyNotes™ effectively unifies every component of your practice, ultimately enhancing the quality of care provided to patients. By prioritizing person-centered documentation and offering searchable diagnoses, this software allows practitioners to dedicate more time to in-session interactions, thereby ensuring that clients receive the attention and care they truly need.

Aquarium’s platform offers an all-encompassing solution tailored for insurance companies in search of a swift, straightforward, and efficient pathway to the market. With a solid history of yielding rapid returns on investment, our platform can be integrated seamlessly into existing IT infrastructures with little disruption. Being a cloud-based solution, it is entirely scalable to accommodate the evolving needs of businesses. The platform comprises multiple interconnected service components, both technical and functional, that create a thorough, end-to-end solution. This integration provides a unified view of customer interactions across various channels, including the web, SMS, email, phone, and traditional mail. It guarantees automated engagement throughout the entire customer journey, covering inquiries, follow-ups, sales processes, mid-term adjustments, renewals, and claims management. Additionally, customer satisfaction is gauged through net promoter scores derived from SMS and email surveys, including keyword and sentiment analysis, ensuring businesses can continuously enhance their service offerings. Ultimately, this comprehensive approach positions insurance companies to thrive in a competitive landscape.

The influence of digital technologies on the insurance sector is profound, with those adapting to these changes set to gain a strong competitive edge. Outdated claim management systems that rely on numerous platforms, physical documents, and labor-intensive procedures are now being supplanted by cloud-based enterprise claim management solutions. The Majesco ClaimVantage Claims Management Software for Life and Health simplifies the entire claims process, encompassing every stage from initial intake to payment calculations, while seamlessly integrating various systems to enhance information flow throughout the organization. By ensuring precise and prompt claim decisions, businesses can elevate customer satisfaction and boost operational efficiency. Additionally, built on the Salesforce Lightning Platform, Majesco ClaimVantage Claims Management Software for L&H empowers insurance firms and third-party administrators to not only modernize their claims handling but also to position themselves for future advancements in the industry. As the landscape evolves, embracing such innovative solutions will be crucial for sustained success.

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.