Alternatives to PLEXIS Payer Platforms

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.

HealthAxis provides integrated solutions to payers, providers, and health organizations. These integrated solutions include an advanced claims processing system, TPA services, and actionable analytics. We simplify operations and improve patient and client outcomes. Healthcare is becoming more technologically connected, but it is still hindered by legacy technology, coordination problems, and information management. We aim to bring innovation to those who are struggling with these issues. Our client philosophy is to be a complete business partner. HealthAxis believes that our success is not based on selling our solutions, but rather on our business partners' continued success and growth. We empower our partners to bring value to the communities that they serve. We thrive with them as they grow their membership and expand their scope. Each member of our team is aware of their responsibility to help our partners realize their potential.

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.

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.

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.

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

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.

The FINEOS Platform stands out as the sole comprehensive end-to-end SaaS core product suite for clients, featuring FINEOS AdminSuite for managing everything from quote to claim, alongside add-on products such as FINEOS Engage to enhance digital interaction, and FINEOS Insight for advanced analytics and reporting capabilities. It serves as a cornerstone for your digital insurance approach. By integrating FINEOS AdminSuite, FINEOS Engage, FINEOS Insight, and robust platform capabilities, the FINEOS Platform establishes itself as the most contemporary single core insurance solution tailored for Life, Accident, and Health sectors. In contrast to outdated legacy core systems that relied on a 'one size fits all' technology model, which is no longer suitable for dynamic businesses, modern consumers, employers, and brokers now benefit from sophisticated SaaS solutions and software that elevate expectations for an insurer's digital initiatives. The previous monolithic insurance software systems primarily concentrated on the intricacies of insurance contracts, overlooking the need for flexibility and adaptability in today's fast-paced market. Embracing the FINEOS Platform means adopting a future-ready approach that aligns with current consumer demands and technological advancements.

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.

Authorize, claim processing and payment are available at the point-of-care. Improve care coordination and improve outcomes for lower medical costs while streamlining administrative processes. Engage providers at point of care to share and capture data in real time, resulting in an unprecedented exchange of health information. We work with our clients to develop risk management strategies that produce better outcomes at lower costs. We aim to improve the user experience of everyone in the ecosystem. To optimize clients' resources, we deliver a minimum of a 3:1 ROI. Conexia has created a core technology platform (ONE), which can be customized to meet the different regulatory requirements and operational processes of each client in each geographic region. Our initial implementation is usually an overlay on the existing technology ecosystem of the payer to create real-time processes.

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.

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.

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

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.

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.

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

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.

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

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.

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.

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.

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

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.

V3locity®, developed by Vitech, is a groundbreaking cloud-based platform for administration, engagement, and analytics that provides comprehensive business functionalities throughout the entire life cycle, alongside powerful enterprise features. This innovative platform seamlessly integrates essential administrative tasks with an exceptional digital user experience. Its modular architecture allows for adaptable and swift deployment approaches, catering to various business needs. Built on a sophisticated cloud-native framework, V3locity harnesses the distinctive advantages of AWS, ensuring a solution that excels in security, scalability, and resilience, ultimately transforming how organizations operate and engage with their clients.

Achieving significant advancements in both clinical and administrative outcomes, Evolent Care Partners, a healthcare system in the Midwest, has earned the distinction of being ranked third nationally for both total shared savings and the percentage of savings against benchmarks. By providing independent primary care physicians with essential capital and resources, Evolent Care Partners empowers them to engage in and thrive under two-sided payer contracts while mitigating their financial exposure. New Century Health enhances cost-effectiveness and quality of care in oncology and cardiology by leveraging clinical evidence to inform care decisions, a process that enjoys support from both payers and providers alike. Furthermore, Evolent Health Services streamlines health plan operations through a suite of comprehensive services backed by a modern, integrated platform and a genuine model of strategic partnership. Additionally, the organization encourages exploration of insights and news related to value-based care, population health, health plan administration, and various topics concerning the transformation of healthcare. Through these initiatives, Evolent aims to foster a more efficient and effective healthcare landscape.

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.

EbixEnterprise serves as an all-encompassing solution for insurance management, effectively optimizing policy oversight throughout its entire lifecycle. The platform comprises six key elements: Customer Relationship Management (CRM), health insurance exchange, policy administration, claims administration, data analytics, and a consumer web portal. These components are interconnected, facilitating the seamless transfer of data in response to various business requirements. SmartOffice CRM empowers organizations to efficiently handle agent and broker details, commission structures, sales pipelines, and state licensing information. Furthermore, the Online Quoting Portal, HealthConnect, stands out as a premier marketplace for both buyers and sellers of health insurance and employee benefits. In addition, EbixEnterprise Administration functions as a robust policy management system, equipping users with all necessary tools to oversee policies, define insurance plans, and maintain associated rate data. This comprehensive approach not only enhances operational efficiency but also drives improved decision-making across the organization.

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

Waystar offers market-leading technology that streamlines and unifies revenue cycle. Their cloud-based platform streamlines workflows, improves financials for all healthcare providers and provides more transparency to the patient's financial experience. Waystar has been ranked best in KLAS for Claims & Clearinghouse every year since 2010. It has also received #1 rankings in Black Book™, surveys since 2012, and the Frost & Sullivan North America Customer Valu Leadership Award for ambulatory RCM service in 2019. Waystar is used by over 450,000 providers, 750 hospitals and 5,000 plans. It integrates with all major HIS/PM systems. Waystar.com and @waystar on Twitter provide more information.

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.

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.

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.

Claim Leader specializes in delivering technological solutions designed to enhance the efficiency of communication and workflow within insurance claims organizations. Our innovative software simplifies operational processes, significantly boosting productivity through a comprehensive and interconnected web platform. The robust modules within Claim Leader's systems facilitate a more straightforward workflow for both administrative personnel and field operators. Additionally, our management tools empower internal users to assign tasks to field personnel, manage workloads, identify files for assessment, and optimize overall workflow efficiency. Ultimately, we are committed to transforming the way insurance claims organizations operate, ensuring a seamless integration of technology into their daily tasks.

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

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.

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.

As a pioneering force and leader in the insurance sector, we boast the most comprehensive straight-through processing platform available in the UK. Discover how our digital solution can cater to your business requirements. Our approach to business transformation emphasizes enhanced agility and a seamless end-to-end digital experience. With self-service options for both advisers and consumers, productivity sees significant improvement. Furthermore, we aim to increase customer lifetime value by fostering proactive and ongoing engagement. Through our Customer and Adviser Portals, users can effortlessly manage their policy documentation and update their personal information in real time. Our platform encompasses every aspect of user interaction, featuring extensive reinsurance reporting, integration with external portals, and both automated and manual underwriting processes. We also offer flexible deployment options, allowing for complete end-to-end installation of the SSG Digital platform or the option to implement individual integrated components, such as underwriting or new business functions, tailored to your needs. Ultimately, this flexibility ensures that your organization can adapt and thrive in an ever-evolving market landscape.

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

OneTouch is a user-friendly application that enables individuals to efficiently send claims or statements to Apex, access the Apex website, and review previously submitted claims directly from their computer's desktop. For OneTouch to function properly, users must register with Apex EDI and establish a username and password. Once these credentials are set up, users can configure OneTouch to take full advantage of its various features. The OneTouch Search function lets users easily locate their claim and statement files submitted to Apex, offering a convenient way to access this information right from their desktop. Within the search feature, users can look for specific patient names, subscriber IDs, and a variety of other criteria. After initiating a search by clicking the search button, users are automatically logged into their Apex webpage to view the search results. To start the search process, simply select your desired search criterion using the dropdown menu represented by a magnifying glass. This streamlined approach not only saves time but also enhances the overall user experience when managing claims and statements.

The Whitespace Platform stands out as a fully digital solution tailored for the global (re)insurance industry. Contracts that are generated and managed through Whitespace consist solely of data. By leveraging digital data for risk transfer instead of traditional formats like Word or PDF files, businesses can unlock the true potential of digital transformation. This shift opens up a world of opportunities, including enhancements in speed, precision, availability, and an expansive array of detailed data for risk assessment, all of which significantly benefit both Brokers and Carriers. Moreover, insurers prioritize the needs of their clients, as a digital interface enables immediate access to risk placements, expedited payments, and quicker claim responses. The comprehensive process is thoroughly supported; with Whitespace, brokers and underwriters can seamlessly create risk submissions, collaborate on contractual agreements, communicate through real-time messaging, request and share quotes, and digitally bind, sign, and endorse (re)insurance contracts, enhancing overall efficiency in the marketplace. Ultimately, this innovative approach not only streamlines operations but also fosters stronger relationships between all parties involved.

Enable your workforce to enhance productivity and lower the overall cost of risk with a Risk Management Information System (RMIS) designed to provide valuable insights and measurable outcomes. Implementing active risk management allows you to equip your employees with the tools they need to effectively navigate risks through a technology platform that is centralized, interconnected, scalable, and driven by data to achieve optimal results. By utilizing Aclaimant’s centralized system, you can successfully minimize accidents, shorten claim lag times, and reduce case durations, all while ensuring your risk management office is seamlessly linked to field incidents. Additionally, you can lower the expenses associated with claims by improving both prevention strategies and mitigation efforts, thereby enhancing your overall insurability. Enhance the effectiveness of your top-tier risk and safety experts with cutting-edge, mobile-first technology and automation solutions. Aclaimant not only keeps your team engaged but also boosts talent attraction, workplace morale, and employee retention rates. Explore a variety of case studies and resources to gain deeper insights into how the Aclaimant platform can be effectively utilized to benefit you and your team, paving the way for a more efficient risk management approach. With these strategic tools, your organization can cultivate a culture of proactive risk assessment and management, ultimately leading to sustained success and resilience.

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.

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.

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.

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.