Average Ratings 0 Ratings
Average Ratings 0 Ratings
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
Tailored solutions for your unique requirements are now within reach. Sustain your ISO 9001:2015 certification effortlessly with inblueQMS, while providing swift solutions to clients using inblueRequest. Capture customer needs and monitor your response times effectively, all while classifying various registers. Experience the convenience of managing everything online, backed by over three decades of expertise in information technology development. The advantages of our software include enhanced centralization for planning, recording, and tracking processes and procedures. You will receive timely reminders for deadlines and notifications whenever a task is assigned to you, delivered via email or through dashboards. The platform is adaptable, allowing you to adjust fields to suit your company's specific realities and to set permissions and deadlines. Enjoy an intuitive user interface designed to simplify your tasks, complete with guided functions. Additionally, you can document comments and versions for thorough tracking, as the system maintains a detailed history of changes. Furthermore, the software provides insightful charts and result reports to help you gauge performance effectively.
API Access
Has API
No
API Access
Has API
No
Integrations
No details available.
Integrations
No details available.
Pricing Details
No price information available.
Free Trial
No
Free Version
No
Pricing Details
$8 per user, per month
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
No
Webinars
No
Live Training (Online)
No
In Person
No
Vendor Details
Company Name
Complete Health Systems
Website
completehealthsys.com/claims/
Vendor Details
Company Name
inblueQMS
Founded
2010
Country
Chile
Website
inbluesolutions.com/request/
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
Yes
Claim Resolution Tracking
Yes
Co-Pay & Deductible Tracking
No
Compliance Management
No
Customer Management
Yes
Electronic Claims
Yes
Forms Management
No
Paper-Based Claims
Yes
Payor Management
No
Policy Administration
No