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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
Choose INSXCloud as your go-to platform for both on-exchange ACA health plans and off-exchange supplemental coverages, including options for dental, vision, accident, and short-term medical. Since the Federal Marketplace was launched in 2014, INSXCloud has been a valuable resource for agents, agencies, and issuers, facilitating the quoting and enrollment processes for individuals and families seeking Affordable Care Act coverage along with ancillary health options. Over the years, we have successfully helped agents and issuers enroll more than 2 million members in a variety of health, dental, vision, and supplemental plans. With our EDE version, e-Commerce is tailored to your needs, enabling both agent-led and direct-to-consumer enrollments. By partnering with us, you retain full control over your marketing strategies, ensuring that your messaging resonates with clients. Our platform also features convenient tools like an enhanced provider lookup to find doctors accepting specific plans and a 'Pay Now' feature available for numerous carriers, streamlining the payment setup for your clients. Additionally, this user-friendly interface makes it easier than ever for you to manage your clients’ healthcare needs efficiently.
API Access
Has API
API Access
Has API
Integrations
No details available.
Integrations
No details available.
Pricing Details
No price information available.
Free Trial
Free Version
Pricing Details
No price information available.
Free Trial
Free Version
Deployment
Web-Based
On-Premises
iPhone App
iPad App
Android App
Windows
Mac
Linux
Chromebook
Deployment
Web-Based
On-Premises
iPhone App
iPad App
Android App
Windows
Mac
Linux
Chromebook
Customer Support
Business Hours
Live Rep (24/7)
Online Support
Customer Support
Business Hours
Live Rep (24/7)
Online Support
Types of Training
Training Docs
Webinars
Live Training (Online)
In Person
Types of Training
Training Docs
Webinars
Live Training (Online)
In Person
Vendor Details
Company Name
Complete Health Systems
Website
completehealthsys.com/claims/
Vendor Details
Company Name
My1HR
Founded
2011
Country
United States
Website
www.insxcloud.com
Product Features
Claims Processing
Adjustor Management
Case Management
Claim Resolution Tracking
Co-Pay & Deductible Tracking
Compliance Management
Customer Management
Electronic Claims
Forms Management
Paper-Based Claims
Payor Management
Policy Administration
Product Features
Insurance Agency
Claims Management
Commission Management
Contact Management
Document Management
Insurance Rating
Life & Health
Policy Management
Property & Casualty
Quote Management