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ease
features
design
support

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Description

HM Health Solutions offers a comprehensive end-to-end solution designed specifically for health plans. With the Enterprise Health Solution, you can obtain the necessary support and achieve the desired business outcomes from a singular, integrated health plan administration platform. This suite of applications and tools oversees a wide range of functions, spanning from sales and enrollment to billing and claims, along with provider and clinical management, as well as customer service. The Enterprise Health Solution (EHS) stands out as the sole verified end-to-end solution that ensures a smooth transition for members from the enrollment stage all the way to claims payment. While other providers may assert that they deliver a fully integrated solution, they often fail to clarify that this may require the sequential purchase of multiple modules to realize true integration. In contrast, the Enterprise Health Solution maintains a singular focus on health plan administration, ensuring that our expertise in the payer space is unmatched. Consequently, when you choose EHS, you are opting for a platform that prioritizes your health plan’s unique needs and operational efficiency.

Description

PwC's SMART (Systematic Monitoring and Review Technology) enhances both the efficiency and effectiveness of evaluating the quality of inpatient and outpatient coding processes while establishing a framework for quality assurance and compliance reviews. In conjunction with the support from PwC Health Information Advisory, SMART reinforces your strategy for monitoring coding accuracy and overall data quality. The SMART Inpatient module features over 1,000 established business rules designed to uncover potential coding errors and opportunities for documentation enhancement, with the option to tailor business rules to meet your specific needs. Comprehensive reporting and data analysis capabilities allow for the assessment of staff performance and the identification of educational needs in areas such as Coding, Clinical Documentation Improvement (CDI), Quality, and Providers. Additionally, the SMART Outpatient module boosts claim accuracy and highlights issues related to charge capture and workflow optimization. By mitigating the risks associated with inaccurate coding, it also fosters better regulatory compliance, ultimately benefiting the entire healthcare organization. Furthermore, the integration of these tools significantly streamlines the coding review process, ensuring higher standards of care and operational efficiency.

API Access

Has API

API Access

Has API

Screenshots View All

Screenshots View All

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

HM Health Solutions

Founded

2014

Country

United States

Website

www.hmhs.com

Vendor Details

Company Name

PwC

Founded

1998

Country

United Kingdom

Website

www.pwc.com/us/en/products/smart.html

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

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

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