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Average Ratings 0 Ratings

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ease
features
design
support

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Write a Review

Description

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.

Description

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 In contrast to outdated legacy core systems that relied on a 'one size fits all' technology model, which is no longer suitable for dynamic businesses, modern consumers, employers, and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.

API Access

Has API No 

API Access

Has API Yes 

Screenshots View All

Screenshots View All

Integrations

No details available.

Integrations

No details available.

Pricing Details

No price information available.
Free Trial No 
Free Version No 

Pricing Details

No price information available.
Free Trial No 
Free Version No 

Deployment

Web-Based Yes 
On-Premises No 
iPhone App No 
iPad App No 
Android App No 
Windows No 
Mac No 
Linux No 
Chromebook No 

Deployment

Web-Based Yes 
On-Premises No 
iPhone App No 
iPad App No 
Android App No 
Windows No 
Mac No 
Linux No 
Chromebook No 

Customer Support

Business Hours Yes 
Live Rep (24/7) No 
Online Support Yes 

Customer Support

Business Hours No 
Live Rep (24/7) No 
Online Support Yes 

Types of Training

Training Docs No 
Webinars No 
Live Training (Online) No 
In Person No 

Types of Training

Training Docs Yes 
Webinars No 
Live Training (Online) Yes 
In Person No 

Vendor Details

Company Name

Complete Health Systems

Website

completehealthsys.com/claims/

Vendor Details

Company Name

FINEOS

Founded

1993

Country

Ireland

Website

www.fineos.com/platform/

Product Features

Claims Processing

Adjustor Management No 
Case Management No 
Claim Resolution Tracking No 
Co-Pay & Deductible Tracking No 
Compliance Management No 
Customer Management No 
Electronic Claims No 
Forms Management No 
Paper-Based Claims No 
Payor Management No 
Policy Administration No 

Product Features

Claims Processing

Adjustor Management No 
Case Management No 
Claim Resolution Tracking No 
Co-Pay & Deductible Tracking No 
Compliance Management No 
Customer Management No 
Electronic Claims No 
Forms Management No 
Paper-Based Claims No 
Payor Management No 
Policy Administration No 

Insurance Agency Management

Claims Management No 
Commission Management No 
Contact Management No 
Document Management No 
Insurance Rating No 
Life & Health Yes 
Policy Management No 
Property & Casualty Yes 
Quote Management No 

Insurance Claims Management

CRM No 
Claims tracking No 
Customer portal No 
Document management No 
EDI data exchange integrations No 
Electronic claims No 
Fraud management No 
Reporting No 

Insurance Underwriting and Rating

Broker / Agent Portal No 
Carrier Upload No 
Commercial Lines No 
Comparative Insurance Rating No 
Customer Portal No 
For Casualty Insurance No 
For Health / Medical Insurance No 
For Life Insurance No 
For Personal Insurance No 
Multi-State No 
Multiple Line Rating No 

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