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Average Ratings 0 Ratings

Total
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

InsightPro is an online platform designed for workforce analytics and operations specifically aimed at health insurance payers, third-party administrators, benefit administrators, and health plans. It facilitates claims management, quality assurance, and support for member contact-center teams. The claims functionalities encompass inventory tracking, task allocation and distribution, production planning, forecasting, KPI dashboards, activity surveillance, and query resolution capabilities. Quality assurance teams are equipped with tools for configurable audits, sampling, capacity planning, error feedback mechanisms, rebuttal workflows, and performance reporting options. The platform's contact-center capabilities include access to member and call-history views, adjustable workflows, real-time insights, and performance analytics. Additionally, workforce dashboards enable managers to oversee productivity, workload, quality, and operational trends, while administrative features aid in user and workflow management. As a SaaS solution, this platform is customizable to meet the unique operational needs of payers, with pricing and plan scope tailored according to customer specifications, ensuring flexibility and adaptability in service delivery. This comprehensive suite of features empowers organizations to enhance their operational efficiency and improve overall service quality.

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

Flexible payment options include monthly plans and pay-per-transaction billing. SaaS pricing is tailored to selected features and customer requirements; no long-term commitment is required.
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 No 

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

MDI NetworX

Founded

2014

Country

United States

Website

insightpro.ai/

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 

Alternatives

Alternatives

No Alternatives
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