Alternatives to TotalEclipse

RXNT's cloud-based, ambulatory healthcare software empowers medical practices and healthcare organizations of all sizes and most specialties to launch, succeed, and scale through innovative, data-backed, AI-powered software. Our integrated, ONC-certified healthcare software system—including Electronic Health Records, Practice Management, Medical Billing and RCM, E-Prescribing, Practice Scheduling, Patient Portal, and more—will streamline clinical outcomes, practice management, and revenue cycle management for your medical organization. RXNT is trusted by over 60 thousand providers and medical professionals across all 50 states in the U.S.A. to drive business growth, optimize operations, and improve the quality of patient care. All of our SaaS-based software products can be purchased standalone, but you can run you entire practice—from encounter to billing—with our unified Full Suite system. It utilizes a secure, central database so your data passes through every product in real-time from anywhere. Using our software, more than 125MM prescriptions have been transmitted and over $7B in claims have been processed. Our predictable, transparent subscription pricing model includes free setup & training, support, mobile apps, and more.

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.

Parascript software automates mortgage and loan document processing faster and more accurately. It also automates insurance document-based tasks that allow for the intake and review of healthcare insurance data. Document processing automation automates the process of processing documents to improve efficiency, data accuracy, and reduce costs. Parascript software is driven by data science and powered by machine learning. It configures and optimizes itself for automating simple and complex document-oriented tasks like document classification, document separation, and data entry for payments and lending. Parascript software processes over 100 billion documents each year in the areas of banking, government, insurance, and other related fields.

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.

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.

The Ahshay Platform, developed by DataCare, serves as a comprehensive database that encompasses a variety of software solutions aimed at enhancing medical management. Among its offerings are tools for managing medical processes, nurse care management, utilization reviews, and automated case management, among others. This versatile platform is designed to meet the requirements of diverse stakeholders, including insurance companies, self-insured organizations, managed care entities, and independent nurse case managers. As a result, it plays a crucial role in streamlining healthcare operations and improving patient care.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

Eligible offers robust APIs that seamlessly integrate insurance billing functionalities into your applications. Our certifications provide reassurance to patients and healthcare providers that Eligible adheres to the highest standards of privacy and security while managing millions of healthcare cases monthly. We recognize the importance of a well-established information security framework in fulfilling both Eligible's and our clients' objectives. We are pleased to share that we have successfully completed our Type II SOC2 audit, which reinforces our commitment to safeguarding protected health information. This achievement not only underscores our dedication to security but also builds trust with our customers and partners regarding our obligations to protect sensitive data. With our APIs, you can effortlessly enhance the patient insurance billing experience for your users, allowing you to run estimates, verify insurance, and submit claims for patients seamlessly. Experience the ease and efficiency that our technology brings to healthcare billing processes.

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.

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.

Introducing the first-ever intelligent medical billing software that caters to multiple specialties. It simplifies the billing process and enhances patient collections for over 75,000 healthcare providers nationwide. With its global data capabilities, there's no longer a need for entering information multiple times. Designed to handle large volumes and intricate data, it features a flexible data structure that meets the diverse needs of various practices and specialties. This software ensures that you receive payments more quickly. You can input payments manually or utilize electronic remittance options. Claims are automatically scanned for errors and any missing details, ensuring accuracy. Additionally, the software can automatically resubmit insurance claims based on predetermined criteria. The rapid review feature allows for swift evaluation and approval of charges. You can audit charges by various metrics, including modality, procedure, insurance, user, or date of service. The intuitive reporting system provides insights into the financial well-being of both front-end and back-end billing processes. You’ll never miss a charge again. Furthermore, it seamlessly integrates with your chosen clearinghouse or statement vendor, making it a versatile choice for healthcare billing. With its user-friendly interface and comprehensive features, this software is set to transform the way medical billing is handled in practices.

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

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.

The rise in total loss claims has reached a concerning 20 percent of all collision and liability losses within the auto insurance sector. Unfortunately, many insurance providers still struggle with disjointed total loss operations, which can result in higher expenses, unhappy customers, and limited oversight. Introducing Total Loss Pro™ from Vemark: this innovative solution is designed to turn the cumbersome total loss claims process into a streamlined and efficient system that can adapt to rapid industry changes. With this tool, you can ensure quicker settlements that enhance policyholder satisfaction. Additionally, it boosts employee morale by minimizing frustration associated with cumbersome processes. This platform also offers improved visibility and transparency, enabling data-driven decision-making. Given the complexities involved in total loss auto claims compared to standard repair claims, Total Loss Pro serves as a cloud-based solution that optimizes every stage of the intricate salvage vehicle workflow, ultimately benefiting both insurers and their clients. Moreover, by implementing this comprehensive tool, carriers can foster a more proactive approach to managing claims, ensuring a smoother experience for all parties involved.

The flagship claims processing solution from Acrometis provides exceptional workflow management by utilizing a configurable rules engine to automatically route documents. This system is built around various elements such as claim assessment scoring, matching body parts to claim compensability, adhering to jurisdictional directives, and scoring relatedness, all aimed at minimizing both the duration and costs associated with claims. Notably, CLAIMExpert can autonomously process 65 percent of incoming medical bills and non-medical documents without requiring any user intervention. Documents that need adjuster review are efficiently flagged and organized to facilitate straightforward decision-making, ensuring that the process remains streamlined. With no need for adjuster involvement for the initial processing, clients often experience an improvement ranging from 11 to 23 points in medical loss within the first year. Furthermore, CLAIMExpert is equipped with rules addressing over 190 different document types, enabling it to swiftly manage whitemail and any other documentation that may arrive at an adjuster’s desk. This comprehensive approach not only enhances efficiency but also significantly impacts the overall claims handling process.

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.

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

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.

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

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.

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.

The process of posting insurance payments exemplifies the 80/20 principle, where a mere 20% of payments, typically those derived from paper EOBs, can consume a staggering 80% or more of the overall workload. However, the introduction of POWEReob changes the game entirely. This service merges free software with a pay-per-transaction model to transform the paper EOBs you still receive from various payers into electronic remittance files that comply with ANSI 835 or NSF formats. These electronic files facilitate automated payment posting to your practice management system, streamline electronic secondary claims billing, and enhance denials management. Importantly, POWEReob is compatible with any practice management software that accepts remittance files from third-party sources, not just those linked to a specific clearinghouse. For practices without such compatibility, we can collaborate with your management system or clearinghouse to ensure you reap the benefits of fully electronic remittances, ultimately optimizing efficiency and reducing labor costs in the payment posting process. By leveraging this innovative solution, practices can significantly enhance their operational workflows and focus more on patient care rather than administrative tasks.

Wisedocs offers a document processing platform that empowers insurance companies, independent medical evaluation firms, and legal entities to handle claims more quickly, accurately, and efficiently. The platform automatically organizes medical records by various criteria such as date, service provider, title, and category. Additionally, it features automated page duplication, which can save up to 30% in both time and costs associated with processing redundant pages. Navigating the administrative challenges of reviewing and sorting medical records can often be daunting, but Wisedocs simplifies this process for insurance, legal, and medical organizations. By creating a tailored medical record index, Wisedocs provides valuable insights that cater to specific requirements. Users can easily access critical information through records that are searchable and indexed, resulting from the medical record review and intelligent summary features. This streamlined approach not only enhances productivity but also helps firms make more informed decisions based on comprehensive data.

Ensure a steady stream of revenue by utilizing a robust platform that accelerates reimbursements through eligibility verification, tracking claims status, conducting audits and appeals, and managing remittances for both government and commercial claims, all integrated into one cohesive system. Take advantage of a sophisticated rules engine that promptly cleanses claims in accordance with the latest CMS and commercial payer regulations, enabling you to rectify any inaccuracies prior to submission. During the claim upload process, confirm eligibility across all payers and identify any flagged issues, allowing for necessary edits before the claims are sent. Reduce the days in accounts receivable by implementing automated workflows for handling audit responses, submitting appeals, and tracking administrative dispute resolutions. Tailor staff workflow assignments based on the specific claim type and required actions. Additionally, automate the submission of secondary claims to prevent timely filing write-offs. Ultimately, enhance your claims revenue through automated workflows that facilitate quicker and more successful audits and appeals, ensuring your organization remains financially healthy. Furthermore, this comprehensive system can adapt to your evolving needs, providing long-term benefits as your operations grow.

E-COMB, or EDI Compatible Medical Billing, serves as a web-based platform designed to create medical claims that adhere to the HIPAA transaction and code set standards mandated by the US Government in accordance with the guidelines established by the American National Standards Institute (ANSI). This solution facilitates the generation, submission, and reconciliation of claims directed towards insurance companies, guarantors, and patients, making it an essential resource for healthcare providers to optimize their revenue by significantly shortening the claims reimbursement process. Additionally, all pertinent information related to the operational context of a Doctor’s Office or Hospital is compiled as Master Data, which is often utilized for claims processing and tends to remain stable over time. This Master Data encompasses critical details regarding Procedures, Diagnoses, Doctors, Payers, and Billing Providers, among others, and is initially created during the setup phase, with the flexibility for updates as necessary. Consequently, E-COMB not only streamlines the billing procedure but also ensures that healthcare professionals have easy access to the most current and relevant information for their operations.

Streamline revenue cycle management, care quality oversight, and workforce optimization through a unified, user-friendly portal featuring single sign-on capabilities. Over 47,000 provider locations depend on our cutting-edge tools to ease the complexities of the patient care experience. Transform the financial experience for patients while alleviating administrative and clinical challenges with the Inovalon Provider Cloud, eliminating the need for fragmented workflows. Our SaaS offerings are designed to enhance both financial and clinical results throughout the patient journey, facilitating improved revenue cycle processes for enhanced reimbursement and ensuring optimal staffing levels for high-quality care. This all-in-one portal enables your organization to elevate its performance, boosting revenue, staff satisfaction, and care standards. By enhancing operational efficiency, productivity, and overall effectiveness, you can unlock the full potential of your organization. Explore the transformative capabilities of the Provider Cloud today.

Amazing Charts Practice Management serves as an all-encompassing platform aimed at improving the workflow and operational efficiency of independent medical practices. Created by a physician with firsthand experience, this solution automates a variety of tasks, including the collection of patient demographics, appointment scheduling, and pre-registration of patients while verifying their insurance eligibility. Additionally, it generates insightful analytical reports and assesses patient financial obligations right at the point of care, while also managing insurance payer lists to facilitate timely and accurate billing processes. This aids practices in collecting payments more efficiently. Among its notable features are tools to monitor unpaid claims, a dedicated claims manager to analyze submissions and minimize denials, and an integrated secure connect clearinghouse that provides robust support and quick adjustments to changes from payers. Moreover, the system boasts intelligent, interactive dashboards tailored to specific roles, which automatically prioritize tasks across various departments, thereby enhancing overall productivity in the medical office. This comprehensive approach ensures that practices not only operate smoothly but also remain agile in responding to the evolving challenges in healthcare administration.

Medical Office One is a comprehensive medical billing software solution that adheres to HIPAA and NPI compliance standards. It is designed for speed and ease of use, facilitating the generation of new CMS 1500 02/12 or UB-04 claims. The software boasts extensive customization options, robust reporting capabilities, and seamless integration with widely-used applications like Microsoft Word, Excel, and Outlook. Users can input claim data directly or retrieve it from the software’s Electronic Medical Records (EMR) system. Additionally, it allows for the printing of CMS 1500 and UB-04 forms, as well as electronic submission of claims to clearinghouses. Medical Office One also features QuickBooks® integration, an advanced SOAP Notes module, and a dynamic chart generator. It enables users to create multiple databases for an unlimited number of providers and practices, all accessible from a single interface. By utilizing this software, you can launch a successful medical billing business from home while efficiently managing both the billing and clinical aspects of your healthcare practice. Furthermore, it serves as a powerful tool for filling out CMS 1500 and UB-04 forms with ease.

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

The KMR Claims Processing Manager is an advanced, fully integrated, and customizable solution designed for Third Party Administrators (TPAs), Self-Insured entities, and Claims Administrators. This sophisticated system features an all-inclusive Medical and Dental Reimbursement module, supports electronic claim submissions, seamlessly integrates with Document Imaging technologies, offers debit card processing capabilities, and ensures full compliance with HIPAA regulations. Additionally, users can easily tailor the system to meet their specific needs and enhance operational efficiency.

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

Our innovative solutions lead to reduced loss costs, minimized expenses, and improved customer satisfaction, demonstrating their effectiveness with top-tier carriers. EvolutionIQ is at the forefront of revolutionizing the claims handling process for intricate coverage lines, fostering a robust collaboration between adept professional adjusters and a uniquely designed predictive guidance system. By providing clear prioritization, proactive claim alerts, and comprehensive context, empowered adjusters are able to lower losses and costs while enhancing the experience for claimants. This approach also mitigates unnecessary variability in the claims process by implementing a consistent and scalable guidance system. Additionally, it optimizes the deployment of adjuster resources, leading to fewer redundant claim reviews and facilitating targeted investigations that help avoid litigation and ensure timely settlements. Our claims AI systematically gathers and utilizes data to offer the strategic guidance necessary for your team’s success. Furthermore, EvolutionIQ integrates both structured and unstructured data from carriers alongside our exclusive third-party data, enhancing overall operational efficiency and effectiveness. This synergy not only streamlines processes but also positions your organization for greater success in the claims landscape.

Our software is developed through a foundation of industry knowledge combined with professional consultancy. This expertise shapes the business processes that are integrated within our platform. 360 offers comprehensive transparency and integrity in claims and risk management, enabling clients to reduce their overall claims expenses. By delivering affordable technology, we enhance outcomes for our clients and revolutionize their operational methods. Our software is customizable to meet the unique requirements of each client and is designed for seamless integration with current systems, freeing up internal resources for value-added tasks that help companies stand out and expand in their markets. This focus on adaptability and efficiency allows businesses to thrive in a competitive landscape.