Best Claims Processing Software of 2024

This product is an all-in-one claims system. The product's primary functions include claims adjudication, claim workflow, and payment disbursement. Flexible design allows for the addition of adjudication modules to be added on a per-line basis. The core functionality of the system is reused for each new line of business. This system makes use of the user-friendly windows screen design and uses a relational database to store data within the system. Powerbuilder is the software platform. It can be used with an SQL database like Sybase or Oracle. This combination of software allows for a client-server based environment that can process large amounts of claims. Installation and training are provided. Source code is included in the license fee. Expert staff can customize the system and tailor it to the client's requirements. All modifications can be made with detailed design and support for acceptance testing.

USSI is proud that it offers its entire range of professional insurance software solutions. These software solutions are designed to be a complete turnkey administration solution. USSI's comprehensive software solutions will ensure that your insurance company operates at the highest level in a changing and competitive market. USSI's InsurancePlus Individual Life and Health Administration software solution manages the books of business for traditional and new non-traditional Life and Health insurance businesses. Products supported include Whole and term life, interest sensitive, final Expense, annuities, supplemental health, and others. USSI's InsurancePlus Group Life and Health Administration software solution manages the books of business for Group Health insurance providers, Self-Insured Funds and TPA's. The supported plan offerings include Point of Service and Major Medical, Term Life and High Deductible, Traditional Insurance, etc.

Rapidly analyze and understand episode costs to accelerate your value-based initiatives. Data-driven, evidence-based discussions about episode costs and individual provider practices patterns will increase provider adoption and engagement. Targeting variations in care delivery and provider performance can help drive cost and quality improvements. Analytics can help you guide network optimization and clinical change by empowering value-based strategies. Analyzing episode costs and using clinically validated episode definitions to identify value-based care opportunities. Engage providers in value-based conversations through analysis of utilization, care variations, and costs. Use episode analytics to optimize network designs, improve consumer engagement, and transform clinical guidelines. By defining the average episode cost and the associated clinical services, you can streamline episode budget creation.

Healthcare providers have to manually enter data for patient accounting tasks, which can be labor-intensive and costly because remittance advice is often populated with thousands of transactions. Healthcare providers are now using computer-aided recognition technology to extract transaction-based data from paper forms in an attempt to automate the process and speed up billing cycles. Although this technology is effective in extracting data elements accurately, there are still many processing tasks that must be completed for EOBs to be successful. The Optiform eobXL™ for Kofax Capture solution has all the features necessary to address these tasks as well as the data integration and image integration requirements. It is intuitive and easy to use.

PlanXpand™, Acero's proprietary transaction processor engine, powers all of our products for administrators of health benefits. Clients can leverage this engine to implement Acero products simultaneously or incrementally. Administrators can choose from one of our standard products or PlanXpand™, which allows them to create a custom solution that extends existing system capabilities. Acero's unique integrated solutions feature Service-Oriented Architecture. This allows health benefits administrators and insurers the ability to add functions and features to existing adjudication platforms. Our sophisticated design and engineering allows real-time adjudication for every type of claim in direct interaction with core claims system. This results in faster processing, happier customers, and less need to adjust claims.

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.

Expedited claims. Multiple interfaces work in conjunction with your corporate brand. Access to digital data from any location, at any time. You can speed up your life and health processing by using faster systems that meet your needs. You can speed up your claims processing to meet the increasing number of claims. At the same time, you can reconcile and resolve more complex claims with record speed. It's here. It's out. There are no interruptions or delays in claims processing. CLAIMSplus expedites claims by working with employers, TPAs, and insurers using robust in-the cloud processing platforms. CLAIMSplusis focused on optimizing processes and expediting medical cases through secure, reliable, and efficient electronic claims management. Our technology, which is the core of our business, manages claims efficiently and quickly. We asked our clients and found that the claim's timeframe is the most important aspect of claims processing.

myClaimStatus is the best tool for your staff to save time and reduce waste. You can get real-time, actionable information about all your claims. myClaimStatus's suite data tools makes it easier to reconcile claims faster. It doesn't really matter how small or large you are. MyClaimStatus allows you to save more on every claim. Are you efficient in your work? MedX medical claims services use robotic process automation in order to maximize workflow efficiency. You can easily reconcile reimbursement rates and your contracted amount to ensure you get what you deserve. You can drill down to see real-time data on every healthcare claim from any payer, regardless of the dollar amount. This is not your typical healthcare claims processing software. Optimize AR follow up activities to work by exception, and get more done in a shorter time.

OneTouch allows users to send claims or statements to Apex easily, log in to the Apex website, and search for claims that were sent in the past from the comfort of their computer desktop. OneTouch can only be used by registered clients of Apex EDI. Users must have a username/password setup. OneTouch can then be set up once a user has created a username/password so that they can access the described tools. OneTouch Search allows you to search all of the Apex claim and statement files from your desktop. OneTouch Search allows you to search your claim and statement files for subscriber IDs, patient names, and many other options. After clicking the search button, you will be logged in to Apex and shown the results of the search. First, click on the magnifying glasses dropdown menu to select what you want to search.

No matter what your EHR, you can meet the challenges of value-based care. With aggregated multi-source data, and an intuitive visual display, you can get a clear view of your patient population. Data-based insights can be used to improve care management, prevent illness, lower costs, and manage chronic conditions. Facilitate care coordination using tools that encourage proactive approaches, such as a pre-visit dashboard and risk stratification. Also, automated tracking of admissions, discharges, and transfer events can be used. Care management is a key component of the operation. Expand physician reach. Encourage patient interaction and follow-up between appointments. Use the Johns Hopkins ACG system to identify patients at highest risk for high-cost utilization. Assign resources to the areas that need it most. Performance on quality measures can be improved. Participate in value-based payments programs and maximize reimbursement.

Claim Leader is a technology company that develops and delivers technology solutions to automate communication and workflow processes within the business enterprise of insurance claim organizations. Our software solutions simplify your operations while enhancing productivity with an integrated web platform. Claim Leader systems' feature-rich modules simplify the workflow for both field staff and internal administrators. Management tools enable internal users to assign tasks to field staff, organize workload, identify files for review, and streamline workflow.

Quick Silver Systems' Mercury allows Automobile, Property, and Casualty insurers to rate, quote, bind, make payment, and report claims online. Online document access, bill payments and the first notice of loss will reduce customer service calls. Modular API-based system allows seamless integration to existing or new data providers. Digital document production is possible and the system can be used on any device. Our visual work-flow creator allows you to create custom, event-driven work-flows. Get the most current information about Written, Earned and Unearned premiums. You can automatically save every page, card and report to share with associates. You can collect currency in any digital format, including ACH, EFT and Electronic Checks, Credit or Bank Card.

A risk management solution for property and casualty. All-in-one benchmarking and claims management system that simplifies claims-related processes and makes adjusters' lives more simple. TerraClaim provides two tools to simplify claims-related operations. These tools are powerful enough on their own, but even more so when combined. An innovative cross-industry data analytics and claims benchmarking solution that compares your claims performance to industry peers. This helps you set better goals, manage risk reserves, and improve claim outcomes. The world's best property and casualty claims management software that streamlines your internal processes, improves productivity, drives desired results, and prevents fraud.

Streamline Your Complete Healthcare Data Workflow. Smart Data Solutions has both the experience and tools to streamline your electronic and paper workflows. Our integrated validation, matching and normalization tools ensure high quality data, increasing auto-adjudication, and decreasing manual processing. Our development process guides you through projects, no matter if you are new to Smart Data Solutions or an existing partner. No matter what your needs are, we will work with your staff to understand them and the impact of your workflows. We believe in focusing your efforts on your goals and what you want to achieve. Then, we will identify the best route to get there.

Connect everyone to your property claim. ClaimLogik connects everyone involved in a property claim, from the first notice of loss to completion. Property assessment & repair ecosystem. We connect everyone involved in your property claim, from start to finish. Stakeholder Management. ClaimLogik connects all stakeholders in a claim with real-time access. This allows them to complete tasks and manage activities in the right order, at the right time and with complete transparency. All stakeholders have access workflow modules that are customized to allow them to track, manage, and complete tasks throughout the claim. Stay connected. All stakeholders connected to one claim. All stakeholders have complete transparency about the claim status. All activities throughout the claim are within your sight. Digital contracts between the Insurer and the supply chain. Service level agreements with all suppliers. Trades KPI management to compare and measure supplier performance. Automated exception management for tasks that fall outside of SLAs

Solutions tailored to your needs. InblueQMS helps you maintain your ISO 9001 certification. With inblueRequest, you can provide fast solutions to your customers. Register your customers requirements, measures your response times. Classify Registers Do everything online. With more than 30 years of experience in the development and maintenance of information technology. Our Software offers many benefits. Centralization Planning, recording, and follow-up on processes and procedures. Reminders. Notifications and reminders sent via email and dashboards when a task is assigned. You can manage it. Modify fields to reflect the needs of your company. Give permissions and set deadlines. It is simple to use. Easy to use, with guided functions that make it easy. Recording. For a better follow up, record comments and versions. Includes a history and description of all changes. Charts and results-reports.

EXPEFLOW's workflow intelligence unlocks a new normal for hybrid work environments, digital transformation and "paperless" processes. Our no-code workflow intelligence allows your employees to concentrate on customer engagement and growing your company. Workflows are lengthy, manual, and often error-prone processes that require employees to repeatedly try to find missing information or key pieces of data. EXPEFLOW's intelligent QuickStart files help you to focus on your customers while increasing operational accuracy and efficiency. Our platform is completely non-code and you are in complete control. Our user interface makes it easy to design your workflows, without the need for additional resources or developers. To create a better customer experience, engage employees and increase productivity. Flexible workflows are essential because customers and industries are different. Our platform has the expertise and domain knowledge to help you work smarter and better.

Service Hub CRM offers outstanding service with ease. It can take customers on average 3 calls to reach them to schedule an appointment. Your employees have the ability to provide Stellar Customer Service. Communication is key to any relationship. We understand that every detail must be taken into consideration. Our software can be customized to meet your business's needs. Consolidating is better than having separate systems. Our team will guide you through our system and teach you how to use it properly. All the information you need is available right from your dashboard. Your technician will give you and your customers the most current status of your tickets. You can track all orders from your smartphone right from your app, which will make it easier to manage them. Never lose your way when you are on the phone with someone. Upload files directly from your phone and get instant access. You will receive notifications directly to your phone about the status of your order.

PwC SMART (Systematic monitoring and review technology) improves the efficiency and effectiveness in your inpatient and outpatient quality evaluation processes and allows for a mechanism to ensure quality and compliance review. SMART, along with the support of PwC Health Information Advisory will help you monitor coding quality and data quality. SMART Inpatient has over 1,000 pre-defined business rules which help to identify potential coding errors and document improvement opportunities. You can also modify business rules to suit your particular areas of interest. Data analysis and reporting help you assess the performance of your staff and identify education opportunities for Coding, Quality, and Providers. SMART Outpatient improves accuracy and identifies areas for workflow improvement and charge capture issues. It improves regulatory compliance and reduces the risk of incorrect coding.

CoreLogic modernizes global property and casualty insurance with flexible, collaborative, and secure claims estimation technologies. We create world-class experiences that simplify life and improve business. Claims Connect™, a CoreLogic®, streamlines the claims process by creating an integrated digital ecosystem. Transform your workflow to ensure that your customer's claims can be resolved quickly and accurately. All information is stored securely on one platform, and can be accessed by all claimants. There is no need to switch between different software programs to edit or review claim information. Claims Connect automatically syncs with Claims Connect to allow everyone to instantly see any changes or create estimates. Your claims resolution will be easier, quicker, and more efficient if everyone involved is up-to-date with the information they require, when they need it.

Reduce costs by administering claims in a way that is unparalleled in efficiency and accuracy. Ventiv is a global leader in risk management, insurance claims, and advanced analytics. Ventiv is helping some of the world's biggest brands with products such as our industry-leading risk analytics solution.

Five Sigma was founded with the mission of enabling claims organizations to innovate. Five Sigma's suite of tools and platform for claims management is what Insurers require to adapt to the rapidly changing world. Our suite of Claims First Cloud-Native products and User-Centric products allows adjusters to better manage claims and do so much faster. Automating administrative tasks allows adjusters to focus on making the right decision, while the system takes care everything else. The complete suite of claims management tools, including an in-system omnichannel communication platform, automated documentation and workflows, reporting, and open APIs. The state-of-the-art claims management platform allows you to go live in just weeks. Five Sigma's unique SaaS offerings, agile methodology, and weekly upgrades make it possible for carriers to improve their claims operations.

Our solutions are proven to be successful at Tier 1 carriers and have lower loss costs, lower expenses and higher customer satisfaction. EvolutionIQ is a partnership between highly skilled professional adjusters and a highly specialized predictive guide system that enables the future in claim handling for complex lines. Empowered adjusters can reduce expenses and losses by providing clear prioritization, proactive claim alerts and rich context. A consistent and scalable claim guidance system will reduce the unintended variability in the claims process. This system allows for more efficient use of adjuster resources and less wasted claim reviews. Targeted claim investigations, litigation avoidance, timely claim settlement. Our claims AI harnesses data to provide the tactical guidance your team requires. EvolutionIQ combines unstructured and structured carrier data with third-party data.

CaseGlide is the leader in claims litigation management. Gone are the days when claims management was disconnected and siloed, manual and inefficient workflows, hundreds of emails between defense counsel and claims teams, and unstructured case data, are gone. CaseGlide allows you to focus on strategy, data, efficiency, and improving your litigation management program. Our clients can better predict and manage the outcome of their cases, assign the right attorneys for the right cases, work more strategically and reduce litigation costs. Integrations allow you to send important case data to your data warehouse, data warehouse, document management or accounts payable systems as your defense attorney partners work on your cases in the platform. It's easy to see that the longer a case remains open, the more expensive it will be.

EMSmart™, claims processing technology, raises the bar and improves your bottom line. EMS IMC's priorities are to use a compliant, accurate, efficient system to manage a complex billing process and maximize your revenue. EMS IMC's new solution, EMSmart™, allows clients to focus on patient care while ensuring that revenue is collected in a compliant way. EMSmart™, our new proprietary claims processing platform, delivers the industry's best rules-based process automation while retaining human judgement at the appropriate points of the revenue cycle process. EMSmart™, our internal processing engine, is now available to you. We are excited to share this information so that you can be confident that your claims are in the best hands possible, both human and machine.