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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
WizWhy analyzes how the values of one data field are influenced by the values of other fields in the dataset. The analysis hinges on a dependent variable chosen by the user, while the remaining fields act as independent variables or conditions. This dependent variable can be examined in two ways: as a Boolean value or as a continuous measurement.
Users have the ability to refine their analysis by setting various parameters, including the minimum probability for rule formation, the least number of instances required for each rule, and the comparative costs associated with false negatives versus false positives.
WizWhy identifies and presents a series of rules that connect the dependent variable with other fields, expressing these rules using if-then and if-and-only-if constructs. Based on the identified rules, WizWhy highlights significant patterns, reveals unexpected rules that may indicate interesting phenomena, and points out unusual cases within the dataset. Additionally, WizWhy is capable of making predictions for new instances by leveraging the established rules.
API Access
Has API
API Access
Has API
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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
WizSoft
Founded
1983
Country
United States
Website
www.wizsoft.com/products/wizwhy/
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
Data Analysis
Data Discovery
Data Visualization
High Volume Processing
Predictive Analytics
Regression Analysis
Sentiment Analysis
Statistical Modeling
Text Analytics
Data Mining
Data Extraction
Data Visualization
Fraud Detection
Linked Data Management
Machine Learning
Predictive Modeling
Semantic Search
Statistical Analysis
Text Mining
Predictive Analytics
AI / Machine Learning
Benchmarking
Data Blending
Data Mining
Demand Forecasting
For Education
For Healthcare
Modeling & Simulation
Sentiment Analysis
Qualitative Data Analysis
Annotations
Collaboration
Data Visualization
Media Analytics
Mixed Methods Research
Multi-Language
Qualitative Comparative Analysis
Quantitative Content Analysis
Sentiment Analysis
Statistical Analysis
Text Analytics
User Research Analysis