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
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
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
Product Features
Alternatives
Alternatives
No Alternatives