Alternatives to HEALTHsuite

Service Center by Office Ally is trusted by more than 80,000 healthcare providers and health services organizations to help them take complete control of their revenue cycle. Service Center can verify patient eligibility and benefits, submit, correct, and check claims status online, and receive remittance advice. Accepting standard ANSI formats, data entry, and pipe-delimited formats, Service Center helps streamline administrative tasks and create more efficient workflows for providers.

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.

Our insurance commissions calculation software saves you time and recovers profit from missed Medicare and other insurance lines. Our insurance commission management software automates tracking missing payments and calculates all commissions, overrides and splits, overrides and bonuses. Multiple carrier reports will automatically be converted into standard formats to allow you to extract useful reports from them. Easily check discrepancies and errors and export these in report format.

Veritable enhances the process of verifying patient insurance eligibility and checking claims status by delivering immediate results through a user-friendly interface. It facilitates real-time and batch processing of patient lists, allowing eligibility verification with over 1,000 payers, including national Medicare and state Medicaid, across various service categories. Furthermore, it provides the capability to monitor claims status from the point of submission to reimbursement, enabling practices and billing firms to swiftly pinpoint issues that could lead to payment delays or denials. Notable advantages include the automation of eligibility and claims processes, which minimizes the need for manual data entry and reduces phone inquiries, thereby enhancing the patient experience at the front desk by confirming coverage and copay amounts during check-in. Additionally, it ensures a smooth integration experience for users of all technical skill levels while maintaining robust data security protocols. Another valuable feature is the “Code Explorer,” which allows for quick reference to ICD-10-CM, ICD-10-PCS, HCPCS Level II, and CPT codes, making it easier for users to navigate coding requirements efficiently. Overall, Veritable streamlines administrative tasks within healthcare practices, ultimately leading to improved operational efficiency and patient satisfaction.

The Virtual Benefits Administrator (VBA) stands out as the top cloud-based software solution for benefits administration in the industry. Offering comprehensive functionality and limitless adaptability, VBA empowers users to effectively create and oversee various health benefits, including medical, vision, dental, disability, Medicaid, Medicare, Medicare Supplement, care management, long-term care, health savings accounts (HSAs), flexible spending accounts (FSAs), health reimbursement accounts (HRAs), and COBRA. This extensive range of services positions VBA as an essential tool for organizations looking to streamline their benefits management processes.

Centauri Health Solutions is a company specializing in healthcare technology and services, motivated by our commitment to enhance the efficiency of the healthcare system for our clients while offering compassionate assistance to those in need. Our software, powered by advanced analytics, supports hospitals and health plans—including Medicare, Medicaid, Exchange, and Commercial sectors—in effectively managing their fluctuating revenue through a bespoke workflow platform. Moreover, our personalized support for patients and members grants them access to vital benefits that can significantly improve their quality of life. Our array of solutions encompasses Risk Adjustment (including Medical Record Retrieval, Medical Record Coding, Analytics, and RAPS/EDPS Submissions), management of HEDIS® and Stars Quality Programs, Clinical Data Exchange, Eligibility and Enrollment services, Out-of-State Medicaid Account Management, Revenue Cycle Analytics, and both Referral Management & Analytics, as well as addressing Social Determinants of Health to further bolster healthcare outcomes and accessibility. Each of these components is designed to work in harmony, ultimately creating a more effective and compassionate healthcare experience for everyone involved.

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.

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.

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.

Safeguard the reliability of your health plan while pinpointing precise pricing with the Context4 Health Plans Suite, our versatile and cloud-centric technological framework. Experience immediate and actionable insights for detecting Fraud, Waste, and Abuse (FWA), developed by our skilled team of certified experts in clinical, dental, and health benefits. By leveraging accurate data and state-of-the-art cloud technology, we deliver a robust and defensible Medicare reference-based pricing (RBP) solution. Our platform comprises over 100 healthcare data sets, complemented by professional guidance to enhance operational efficiency and ensure regulatory compliance. Additionally, our sophisticated medical coding software is tailored to streamline claim submissions and reduce the likelihood of denials. Furthermore, the cloud-based Payment Integrity Platform harnesses our unique analytics engine to uncover coding mistakes, assess medical necessity, address unbundling, detect fraud, waste, and abuse, evaluate audit risks, and identify pricing discrepancies, all of which can significantly influence your organization's performance. This comprehensive approach not only safeguards your financial health but also positions you for sustainable success in the ever-evolving healthcare landscape.

William, the advanced automated premium billing and payments platform by Certifi, streamlines membership accounting, payment management, collections, and remittance specifically for digital benefits-based billing. With William, users can enjoy the convenience of fully electronic billing transactions across intricate billing situations, which include payer-sponsored marketplaces catering to both group and individual demographics, as well as specialized segments like Medicare Advantage and Medicaid. This robust enterprise-class accounting system ensures compliance with GAAP standards while providing clear audit trails for effective general ledger management. Additionally, all customer-facing invoices, reports, portals, and tools are customized to align seamlessly with your organization's branding. The platform also features rules-driven communications for managing delinquency and policy terminations, facilitating everything from initial notifications to eventual policy suspension or termination. Moreover, both consumers and employers benefit from the flexibility to establish either one-time or recurring payments, utilizing their preferred methods of payment. This comprehensive approach not only enhances user experience but also reinforces the importance of maintaining financial accuracy and transparency within the billing process.

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.

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.

Boost your organization's cash flow by efficiently handling claims from Medicare, Medicaid, and various commercial payers. With our automated system, you can process all payer claims in real-time from any location, ensuring faster payment for your claims. You have the ability to submit and monitor your claims at any moment, benefiting from real-time updates on their status. A dedicated account manager, who is a certified healthcare claims expert, will be assigned to you, and you will even have their mobile contact number for immediate assistance. Expand your revenue streams and enhance your cash flow through our automated claims processing, which provides complete visibility into all your electronic funds transfers (EFT) and payment forecasts. You can streamline the processing, tracking, and resolution of claims in real-time to maximize revenue and eliminate time-consuming tasks. Additionally, our system automates Medicare eligibility verification alongside claims processing to further enhance efficiency. By adopting this approach, you can significantly reduce administrative burdens and focus on what matters most—providing excellent care to your patients.

Enhance your claims management process while reducing denials with superior edits and a top-tier clean claim rate. Healthcare organizations need advanced technology to ensure precise claim submissions and swift reimbursements. Claims Director, the claims management solution from SSI, simplifies billing procedures and offers transparency by assisting users throughout the entire electronic claim submission and reconciliation journey. As reimbursement criteria from payers undergo modifications, the system continuously tracks these changes and adapts accordingly. Furthermore, with an extensive array of edits across industry, payer, and provider levels, this solution empowers organizations to maximize their reimbursement efforts effectively. Ultimately, utilizing such a comprehensive tool can significantly improve financial outcomes for health systems.

SpyGlass, our advanced software for managing health claims at the enterprise level, presents a robust and adaptable solution for efficient and accurate claims processing. The platform simplifies the setup of benefits and plans significantly. Fully integrated with SpyGlass, BenefitDriven offers eligibility verification, contribution accounting, and pension management specifically tailored for the Taft-Hartley sector, encompassing a comprehensive suite of data and processes for both Participants and Employers. Our all-encompassing EDI gateway and scheduler, HIPAA Director, functions as a central hub, enabling seamless connections with vendor partners to minimize transaction costs, streamline batch transfers, and automate the transfer process. With SpyGlass, you gain an in-depth, panoramic view of your population while also having the capability to drill down to granular details with ease. You can access an extensive selection of unique reports, fully customizable dashboards, and maintain total control over your system, ensuring that you have everything you need at your fingertips to make informed decisions and optimize your operations. In this way, SpyGlass empowers organizations to enhance their efficiency and effectiveness in managing health claims.

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.

AgentExpress stands out as an innovative quoting and enrollment platform, transforming the conventional CMS experience to empower brokers in the dynamic world of insurance. Our unique approach combines technology, comprehensive training, and unwavering support to enable agents to deliver exceptional service to their clients. With decades of expertise in both the insurance and tech industries, AgentExpress leads the market in broker technology solutions for Medicare Advantage, MAPD, PDP, Medigap, ACA, Ancillary, and Final Expense Life. When you partner with AgentExpress, you gain a dedicated team focused on your business success. Expand your enterprise through extensive product knowledge, advanced technology, and sales training, which can be accessed via our weekly webinars, collaborative training sessions, or through our pioneering micro-learning platform designed specifically for insurance professionals. This commitment to agent development ensures that you are always equipped to adapt to the industry's evolving demands.

Optimize Your Entire Healthcare Data Process. Smart Data Solutions possesses the expertise and tools necessary to enhance both your paper-based and electronic workflows. Our suite of integrated tools for validation, matching, and normalization guarantees the highest quality data, which enhances auto-adjudication and minimizes the need for manual processing. Regardless of whether you're a newcomer to Smart Data Solutions or a long-standing collaborator, our development process is designed to support you throughout your projects to maximize your chances of success. Our dedicated team will take the time to grasp your unique needs and the implications of your workflows, addressing both straightforward and intricate requirements. We prioritize your objectives, focusing on what you aim to achieve and then determining the most effective strategies to reach those goals. Smart Data Solutions delivers comprehensive front-end pre-adjudication services for numerous Payers across the country, ensuring flexibility in our offerings. Whether your requirements are minimal or you demand a fully tailored workflow, Smart Data Solutions is equipped with a diverse range of solutions to meet your needs. Our commitment to excellence sets us apart in the industry.

EzyMed Online 4 serves as a complete Medical Practice Management solution tailored for General Practices, Radiology, and Specialist Centres in Australia. Specifically designed for the unique needs of the Australian healthcare landscape, it offers all the necessary features to facilitate Medicare Australia’s Online Claiming, as well as Department of Veterans Affairs (DVA) Claims and Australian Childhood Immunisation Register (ACIR) claims. This integrated system allows for efficient management of your practice with minimal effort, streamlining operations through user-friendly navigation. It employs a secure database management system, ensuring optimal performance and reliability even when handling vast amounts of data, including over a million records. Once a patient registers at the reception, EzyMed Online 4 meticulously tracks the consultation process, storing all information in a digital format within the patient’s database. This enables healthcare providers to access a comprehensive medical history at any time, including records of every appointment ever logged, thereby enhancing continuity of care and service quality. In summary, EzyMed Online 4 not only simplifies administrative tasks but also boosts the overall efficiency of medical practices.

At the heart of PBM Express lies the adjudication program, where claims undergo extensive edits to ensure precise processing outcomes, no matter how complex the plan design may be. The parameter drive program supports a highly adaptable framework that facilitates client-specific customization as required. Laker's cutting-edge software solution equips clients with exceptional performance and top-notch uptime that leads the industry. As a frontrunner in technology, Laker consistently upgrades and improves its systems to address the evolving demands of its clientele. Customers of Laker benefit from having access to the fastest, most versatile, and most resilient system in the market. Furthermore, Laker collaborates closely with its clients to conceive, test, and roll out new products, empowering them to enhance their competitive edge and secure new business opportunities. As client claim volumes increase, Laker evolves alongside them, underscoring the mutual benefit for both parties in implementing prompt and efficient software changes to support this growth. This commitment ensures that Laker remains a valuable partner in its customers' success.

Oracle's Digital Insurance Platform equips insurance companies with the tools needed to create cutting-edge solutions and outstanding digital experiences for customers. This all-encompassing system simplifies everything from sales channels to back-office functions, allowing for quick introduction of new products and easy adaptation to changes. By leveraging real-time analytics, insurers can acquire critical insights that support better decision-making processes. The platform accommodates both individual and group life insurance, as well as annuities, by integrating underwriting, policy management, billing, and claims handling into one streamlined system. Health insurance providers experience enhancements in enrollment procedures, premium billing, and claims processing, which leads to greater member satisfaction thanks to clear and tailored services. Furthermore, the platform improves the bancassurance process by facilitating immediate connectivity between banks and insurance firms, which guarantees efficiency, uniformity, and trust. This interconnected approach fosters a more dynamic insurance environment, ultimately benefitting both providers and their clients.

SmartEMR is an online electronic medical records platform designed to help doctors efficiently document patient visits and interpret test results. It is customized to align with the physician's daily routines, promoting a seamless and intuitive experience while generating reports that adhere to the standards set by the Centers for Medicare and Medicaid Services (CMS) for coding and reimbursement purposes. Additionally, SmartEMR functions as a medical billing tool, enhancing the reimbursement process through its CMS-compliant Superbill generation feature. Claims submitted electronically through the system are prioritized, leading to a quicker processing time for reimbursements. By optimizing the reimbursement workflow and minimizing costs, SmartEMR significantly enhances your cash flow, making financial management easier for healthcare providers. This comprehensive solution ultimately allows physicians to focus more on patient care rather than administrative tasks.

Utilize a cloud-based healthcare delivery system to effectively manage your members' healthcare and networks. This system streamlines the claims processing for managed care organizations by automating various tasks such as eligibility verification, referral and authorization handling, provider contracting, benefit management, auto adjudication of claims, capitation for primary care and specialty services, EOB/EFT check processing, as well as EDI transfers and reporting. It can be implemented as a cloud solution or operated in-house, making it suitable for a range of entities including managed care organizations (MCOs), independent physician associations (IPAs), third-party administrators (TPAs), preferred provider organizations (PPOs), and self-insured groups. By simplifying the intricate processes involved in managing eligibility, referral authorizations, and claims, this system enhances operational efficiency. Its features are designed to optimize data integrity while minimizing the need for manual data entry, thus improving overall accuracy and productivity. Additionally, the flexibility of deployment options ensures that organizations can choose the best fit for their operational needs.

Whether you need assistance with grasping the intricacies of the CMS and ONC final regulations, crafting a strategy to meet compliance deadlines, or executing a practical solution, we are here to assist you. As a frontrunner in the field of interoperability, Edifecs possesses the necessary expertise to guide you in achieving adherence to the latest mandates while unlocking the potential of secure and dependable electronic health data exchange. Edifecs provides top-tier Smart Trading and Encounter Management solutions specifically designed for small to medium-sized health plans. By leveraging financial, clinical, and administrative data, organizations can advance their business strategies and facilitate automation in administrative tasks. Improve encounter management processes and enhance first-pass rates for managed Medicaid and Medicare Advantage through a hosted solution model that Edifecs offers. Additionally, Edifecs presents COTS-based modular solutions aimed at optimizing data quality and supporting payment reform initiatives. By utilizing these innovative tools, health plans can ensure a proactive approach to compliance and data management, ultimately leading to improved outcomes.

DCI specializes in assisting providers and government entities within the Medicaid, Medicare, and Managed Care sectors. Our innovative software solutions enhance operational efficiency, empowering you to effectively support the direct care industry across diverse regions, from urban centers to remote locales. With our dedicated team, we can have you operational in less than 90 days. Are you seeking to optimize the authorization process for your healthcare organization? At Direct Care Innovations (DCI), we provide a Real-Time Authorization Management Module integrated into our comprehensive business management platform. This module is crafted to function as a real-time data management and reconciliation tool for authorizations related to Medicaid, Medicare, Managed Care, and various service code-based insurances. It acts as the definitive record system for agencies to access and manage their service authorizations seamlessly, ensuring efficient and accurate oversight. By implementing our solutions, you can significantly enhance the workflow and accuracy of your agency's authorization management processes.

Eliminate unnecessary double redirects to enjoy a seamless enrollment process on a unified platform, allowing you to complete Special Enrollment Period (SEP) verifications, navigate complex eligibility scenarios, and manage life changes without the need to visit ‘healthcare.gov’. Our EDE platform utilizes efficient application-programming interfaces (APIs) to facilitate rapid data transfer with the Federally-Facilitated Exchange, ensuring quicker submissions, eligibility assessments, and renewals. These APIs swiftly compute the relevant cost-sharing reductions and premium tax credits for users. Additionally, the Medigap Filters feature aligns with regulatory requirements, enabling you to quote, compare, and add optional riders for Medigap plans directly within BrokerEngage, eliminating the hassle of searching through various carrier portals. Furthermore, you can easily discover plans for your clients that encompass the healthcare providers and prescription medications they require, making the entire process more convenient and tailored to their needs. This comprehensive approach simplifies the enrollment journey while ensuring compliance and efficiency.

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.

Introducing the most effective and precise solution in the market for handling claims, the CyberSource Medical Claims Scanning Solution is a fully integrated system designed for HMO, PPO, TPA, or Self-Funded Organizations. This system is set up at your facility to facilitate automated data entry for various forms including CMS-1500, ADA-2006, UB-04, and enrollment documentation. By leveraging sophisticated "intelligent" features along with your specific business protocols, CyberSource adeptly identifies, verifies, and formats data extracted from medical claim submissions. Its Fuzzy Matching technology smartly searches through your member and provider databases to ensure accurate identification of data matches. Once the data is matched, it is used to confirm and rectify information on the medical claim prior to moving it to the adjudication stage. The synergy of top-tier OCR capabilities, your unique business guidelines, and efficient Fuzzy Matching contributes to outstanding precision in processing data from your medical claims forms, ultimately enhancing operational efficiency. Through this innovative solution, organizations can significantly minimize errors and streamline their claims processing workflow.

Founded in 2000, DataGenix is dedicated to delivering innovative claims processing solutions to third-party administrators, adjusters, and insurance firms. Recognizing the complexities that can arise in claims processing and health benefits management, our team has developed the sophisticated ClaimScape software designed to streamline the entire adjudication process, ensuring your business remains unaffected by potential losses. Our mission is to tackle the challenges that prevent an exceptional customer experience for your clientele. By aligning our offerings with current trends and demands, we are committed to facilitating your organization's growth through our software solutions. Trusted by leading TPAs nationwide, we are eager to expand our services to a broader audience. As we continue to evolve, we aim to set new standards in the industry.

QNotes Office™ provides a reliable and secure solution for managing medical records. You can create notes using our Portable Solutions like PDQ Touch Notes™ or QuiX™, or opt for traditional typing, voice dictation, or Easy Reports™. Our platform is fully compliant with HIPAA and Medicare regulations. With patient charting features designed to safeguard against Medicare Audits, Medical/Legal Challenges, and Catastrophic Loss, QNotes Office™ offers peace of mind. The introduction of our QDaySheet™ system enhances your billing process, ensuring you receive timely payments. Our systems are user-friendly and designed for easy ownership. Enjoy the benefits of safe and secure medical records along with patient charting that meets all compliance standards! We provide essential protection for practices against Medicare Audits, Medical/Legal Issues, and unforeseen losses. Additionally, our solutions are straightforward for staff to grasp, with a learning curve of under an hour. Key features include transcription capabilities like Document Export, Save to PDF, and Batch Print, all of which function seamlessly with your preferred Voice Recognition software. Experience efficiency and security combined in one comprehensive package!

As Medicare regulations evolve annually, all home health providers will soon be mandated to implement electronic medical records systems for efficient patient information management. Turn Key Therapy provides a proactive solution that gives you a competitive edge in this landscape. TheraTracker is a comprehensive, cloud-based software that enables users to oversee the entire home health therapy process anytime, anywhere, throughout the year. Both individual therapists and therapy staffing firms utilize TheraTracker as a foundational tool to expand their operations. Additionally, home health agencies also turn to TheraTracker for its superior functionality, surpassing that of their costly and outdated software. This software was specifically designed by experienced home health therapists who understand the intricacies of the field and management. Each feature in TheraTracker is meticulously crafted to ensure therapists remain compliant with the latest Medicare requirements while providing a framework that promotes excellence in documentation and communication. By choosing TheraTracker, you are not just adapting to changes; you are setting yourself up for success in a fast-evolving industry.

EvolveNXT’s platform is designed for health insurance carriers and any commission-based business, providing a customizable suite of solutions that enhance sales performance and simplify the management of intricate business processes. With over ten years of experience collaborating with top insurance carriers, we have crafted a solution tailored to meet the demanding requirements of competitive and regulated markets. Our compliance-focused approach allows organizations to boost the efficiency of their sales channels while promoting sustainable growth in enrollment. Notably, the intricate commission structures that apply to Medicare brokers are among the most challenging to navigate; EvolveNXT facilitates the management and automation of Medicare compensation while ensuring adherence to CMS regulations. By utilizing our commission management software, insurance carriers can not only streamline their operations but also empower their teams to achieve peak sales performance, paving the way for greater success in an ever-evolving industry.

Approved Admissions is a secure platform that automates tracking of coverage changes for Medicare, Medicaid, and commercial payers bundled with real-time eligibility verification and coverage discovery. The platform's primary goal is to help providers minimize the number of claim denials due to a missed insurance coverage change and accelerate the billing cycle. Approved Admissions Features: - Automated eligibility verifications and re-verifications - Email or API notifications if any coverage changes are detected - Real-time verifications - Batch eligibility verification - Seamless integration with RCM, EHR platforms (PointClickCare, MatrixCare, SigmaCare, DKS/Census, FacilitEase, and many others) - RPA-powered cross/platform synchronization

Anagram Prosper allows you to return funds to your patients without imposing any costs on your practice. By enhancing your profit margins and pleasing your patients, you can eliminate the need for courtesy discounts. We have collaborated with top vendors to create wholesale price lists that cater to both your requirements and those of your patients. You can offer rebates on products you already have in stock, encouraging patient engagement and driving increased sales while boosting your revenue. With Anagram Prosper, you not only save your patients money but also maintain your profit margins without resorting to discounts. Utilize our rebate program to enhance customer satisfaction and stimulate more purchases. Many patients are unaware of their out-of-network benefits, and Anagram Access allows you to access real-time vision plan eligibility to ensure maximum savings for them. This tool enables you to swiftly determine the patient's financial responsibility while also showing how much they can expect to be reimbursed by their vision plan, making the entire process smoother and more efficient. By leveraging these innovative solutions, you can elevate your practice while providing exceptional value to your patients, ensuring they leave satisfied and informed.

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.

Reach is a specialized tool from DDG that aids FMOs in effectively targeting audiences within the senior market. This innovative platform provides same-day service, offering a comprehensive view of essential descriptor variables to pinpoint the most suitable audience for products like Medicare Advantage, Medicare supplements, and final expense insurance, among others. By supplying the exact names and addresses of individuals in the desired demographic to your selected mail supplier, Reach enhances the precision of customer acquisition strategies that are customized to reflect the unique characteristics of your county. Utilizing advanced modeling techniques, including the look-alike model, Reach helps create tailored audience profiles that inform and refine your advertising messages. Additionally, the response model estimates the potential success of campaigns, allowing for more efficient allocation of direct marketing funds by focusing on individuals who are most likely to make a purchase. Beyond its powerful modeling capabilities, Reach upholds stringent data security measures, holding a SOC 2 Type 2 certification, and expertly oversees the entire modeling workflow, which includes managing deceased records and adhering to USPS guidelines. Ultimately, Reach not only streamlines the audience targeting process but also enhances the effectiveness of marketing efforts in the senior market.

WLT’s MediClaims system presents an economical, user-friendly, and highly effective solution for managing benefits and claims. Its rules-based framework combined with integrated EDI functionalities ensures that claims are handled swiftly, simply, and with precision. The system is designed to manage a diverse array of benefits and claims, including Medical, Dental, Vision, Prescription Drugs, Consumer-Driven Healthcare, Disability, and Capitation processing. With WLT's MediClaims, you can easily customize the configuration of your groups to accommodate either a single line of coverage or intricate benefit plans with multiple coverage lines. To achieve operational efficiency, a robust information system is essential, and WLT consistently utilizes cutting-edge technologies, delivering you the most advanced and adaptable systems available in the market. In an ever-evolving healthcare landscape, having such a dynamic claims processing system is crucial for maintaining competitive advantage and ensuring customer satisfaction.

EMCsoft's Claims Management Ecosystem guarantees that healthcare providers and billing companies submit accurate claims to insurance payers for effective claim processing. This system combines our adaptable claims processing software, Claim Agent, with a comprehensive methodology known as the Four Step Methodology, seamlessly integrating into your claim adjudication workflow. By implementing this strategy, we enhance, facilitate, and automate your processes to optimize claim reimbursements. For an insightful overview of Claim Agent's features and its integration into your claims process, you can request our complimentary online demonstration. Claim Agent efficiently manages the scrubbing and processing of claims, ensuring a smooth transition from provider systems to insurance payers in a timely and cost-effective manner. The software is designed to be compatible with any existing system, ensuring a swift and straightforward implementation. Furthermore, we offer tailored edits, bridge routines, payer lists, and workflow configurations that cater specifically to each user's requirements, enhancing the overall claims management experience. This personalized approach enables healthcare providers to focus more on patient care while we take care of the complexities of claims processing.

Streamline the complete claims process by automating steps from the initial loss notification and fraud detection through to adjudication and final settlement. Enjoy the capability to handle various claim types distinctively, such as death claims and maturity claims, while enhancing adherence to regulations and avoiding penalties for non-compliance. Achieve more efficient and precise processing with features for data collection, payment oversight, salvage and recovery management, legal case processing, and comprehensive monitoring. Ensure effective registration, adjudication, tracking, and oversight of all claim submissions. Utilize integrated and detailed business rules that enable claims to be categorized automatically into “fast track” or “non-fast track” categories. Additionally, you have the option to easily add or adjust stakeholders involved in the process, including garages, assessors, loss adjusters, surveyors, investigators, and claims officers, to further enhance operational efficiency. This comprehensive approach not only simplifies workflows but also fosters collaboration among all parties involved in the claims journey.

Endear is a white-labeled platform connected via API that enables you to offer state-of-the-art benefits and programs without the technical complexities typically involved. Our adaptable onboarding process also equips members with the knowledge to fully utilize their plans. By collaborating with progressive Medicare Advantage plans, ACOs, and DCEs, Endear aims to enhance star ratings, streamline the onboarding journey, alleviate technological challenges, and stand out in a saturated marketplace. The Endear platform consolidates access for members, providing a centralized hub for all core and supplemental benefits, as well as various member tools, resources, and any third-party vendors you may be collaborating with. Our user-friendly interface, designed to reflect leading consumer brands, minimizes confusion and reinforces the trust your members place in their healthcare plans, ultimately fostering a more positive user experience. This comprehensive approach not only simplifies the process for users but also enhances their overall satisfaction with the services provided.

MACRA affects all healthcare providers who have over $90,000 in Part B billing and serve more than 200 Medicare patients annually. Physicians are evaluated against their peers, which could lead to adverse changes in their overall Medicare income. There are two primary reimbursement initiatives: MIPS and Advanced APMs. Additionally, the Patient Portal serves as an invaluable resource to enhance the communication between your practice and patients. The features integrated into the MEDENT system are unparalleled in terms of practice management capabilities. Our EMR/EHR solution is meticulously crafted with an emphasis on both efficiency and dependability, ensuring that healthcare providers can focus on delivering quality care. By leveraging these advanced tools, practices can significantly improve their operational workflows and patient engagement.

Utilize our exclusive Claims Analysis tool to efficiently save both time and financial resources by identifying bundled codes alongside the Medicare allowable amounts. Eliminate the frustration of navigating through numerous online resources, as we consolidate everything you need in a single platform, including fee schedules, drug lookup, CMS transmittals, and additional resources. Each claim undergoes a meticulous review with over 30 specific code edits to ascertain whether CMS considers the code bundled to the SNF. Our comprehensive database encompasses more than 16,000 Medicare billing codes along with data for 112 geographical locations. We provide detailed reports reflecting the Medicare allowable amounts tailored to your specific zip code. Our service includes fees from all relevant CMS fee schedules, covering areas such as physician services, ambulance, ambulatory surgery centers, DMEPOS, drugs, laboratories, PEN, and hospital outpatient settings. We also provide carrier-priced codes for those carriers that report their prices to ensure transparency. Any CMS coding inaccuracies are promptly corrected on our platform as they are discovered, and you can conveniently save all your reports for future reference. This way, you can streamline your claims process and enhance your operational efficiency.

Origami Risk offers cohesive SaaS solutions tailored for a diverse range of clients, including insured entities, brokers, insurers, third-party claims administrators, and public organizations, which empower them to enhance their workflow management, utilize analytics effectively, and improve stakeholder engagement. Consistently recognized as a five-time recipient of the Business Insurance Innovation Award, we maintain this accolade by working collaboratively with our clients to create solutions that tackle real-world issues they encounter. Since our inception, Origami Risk has committed to providing top-tier, practical solutions for risk management professionals worldwide. Our recognition with the 2021 European Risk Management Award for Technology Innovation of the Year highlights our ongoing dedication to excellence. We focus on delivering fully-integrated and comprehensive solutions aimed at minimizing incidents and hazards, reflecting our commitment to innovation in the risk management sector. By prioritizing client collaboration, we ensure our offerings remain relevant and impactful in an ever-evolving landscape.

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.