Best Healthcare Claims Management Software for Nonprofit - Page 3

Discover an analytics-focused solution for managing claims and remittances designed specifically for healthcare providers aiming to streamline workflows, optimize resource use, reduce denial rates, and enhance cash flow. Boost your initial claim acceptance ratio with our extensive editing package that keeps you updated on the latest payer guidelines and regulations. Elevate your team's efficiency by utilizing user-friendly workflows that prioritize exceptions and automate routine tasks. Your team can conveniently access our versatile, cloud-based platform from any computer to ensure seamless operations. Effortlessly handle your secondary claims volume with the automatic creation of secondary claims and explanations of benefits (EOB) based on primary remittance advice. Leverage predictive artificial intelligence to concentrate on claims that require immediate attention, allowing for quicker error resolution and minimizing the risk of denials prior to submission. Achieve greater efficiency in your claims processing, whether you’re printing and dispatching primary paper claims or including organized claims and EOBs for secondary submissions. By implementing these advanced features, you can significantly enhance your overall claims management strategy.

Utilizing intelligent automation to handle large volumes of medical claims enables organizations to achieve remarkable efficiency that extends beyond mere cost reduction. For those still depending on manual methods, the task of processing medical claims documents and data is not only time-consuming but also prone to mistakes, which introduces unwarranted risks into the workflow. With Artsyl's ClaimAction medical claims processing software, your organization can enhance profit margins, reduce the number of manual interactions, and eliminate obstacles in the processing chain. This software allows for the seamless capture of medical claims data without the necessity for intricate custom coding. It also ensures that claims data and documents are automatically directed to the appropriate claim examiner, adhering to your established business rules. By enabling the configuration of intricate benefits and reimbursement protocols, the software aids in expediting processing times and mitigating payment delays. Additionally, it empowers organizations to swiftly adapt to evolving government regulations, thereby ensuring compliance across data, documentation, and processes. Ultimately, adopting this advanced solution can transform your claims processing approach, paving the way for improved operational excellence.

To utilize our software, all your practice requires is an internet connection and a web browser; indeed, there’s no need for downloads or any third-party applications. Veracity’s laboratory interface enables you to tailor your lab ordering experience, effectively saving you valuable time. Orders are submitted effortlessly, and results are returned promptly for timely follow-up. Our platform is accessible on both Android and iOS, featuring a fully operational mobile app that lets you manage your schedule, prescribe and refill medications, and access lab results, imaging outcomes, chart notes, phone interactions, messages, patient summaries, and much more. This system enhances medication safety and improves patient outcomes by ensuring consistent and accurate clinical information throughout your workflow. Additionally, you can create virtual appointments that facilitate quick and efficient patient consultations, allowing you to manage your practice without interruptions from daily life. This approach simplifies your workflow and provides assistance to those unable to visit your practice in person, making healthcare more accessible for everyone involved.

Startech Software’s TotalEclipse™ is a comprehensive Claims Management and Medical Bill Review Software application that operates on a single-database system. After more than three years of rigorous development and testing, this product has been crafted by actual claims adjusters, bill reviewers, and administrative managers who rely on this essential software in their daily operations. While many software developers prioritize user experience, TotalEclipse engages users directly in its development process. This collaborative effort results in an application tailored to real-world workflows, emphasizing easy access to the most frequently required information in the field. TotalEclipse is equipped with the advanced processing capabilities, functionality, and reporting features necessary to enhance productivity while effectively managing expenses. With a backend that supports scalability, it can be utilized on either the Microsoft SQL Server™ or Oracle™ platforms, making it versatile for various organizational needs. Additionally, the software's design reflects a commitment to continuous improvement based on user feedback, ensuring it evolves alongside the industries it serves.

Medical Office One is a comprehensive medical billing software solution that adheres to HIPAA and NPI compliance standards. It is designed for speed and ease of use, facilitating the generation of new CMS 1500 02/12 or UB-04 claims. The software boasts extensive customization options, robust reporting capabilities, and seamless integration with widely-used applications like Microsoft Word, Excel, and Outlook. Users can input claim data directly or retrieve it from the software’s Electronic Medical Records (EMR) system. Additionally, it allows for the printing of CMS 1500 and UB-04 forms, as well as electronic submission of claims to clearinghouses. Medical Office One also features QuickBooks® integration, an advanced SOAP Notes module, and a dynamic chart generator. It enables users to create multiple databases for an unlimited number of providers and practices, all accessible from a single interface. By utilizing this software, you can launch a successful medical billing business from home while efficiently managing both the billing and clinical aspects of your healthcare practice. Furthermore, it serves as a powerful tool for filling out CMS 1500 and UB-04 forms with ease.

PDS Cortex enhances the efficiency of your practice by offering comprehensive tools for overseeing patient appointments, billing, collections, and much more. It simplifies the intricacies of the current health insurance landscape, making it easier for practices to adapt. Some of its standout features include medical billing, which serves as the core of Cortex with dynamic cash flow management, reduced accounts receivable, and efficient data retrieval and analysis. It also provides robust insurance management tools that allow you to effectively track, manage, and report while saving valuable time. Additionally, it enables monitoring of bad debts and collection agency performance, enhancing accounts receivable efficiency. The appointment scheduling feature is user-friendly, offering customizable layouts and a powerful workflow to streamline operations. Furthermore, electronic remittance distribution allows for better control through the electronic posting of insurance payments, optimizing your insurance transaction processes. Lastly, the platform offers over 270 standard reports, providing you with the flexibility and control needed to make informed decisions based on comprehensive data insights.

Remittance360 is a valuable tool that can be leveraged by all entities within the healthcare revenue cycle industry. When organizations receive standard 835 files, staff members across various departments will benefit from this resource in making informed decisions related to cash flow and accounts receivable processes. The user-friendly nature of Remittance360 allows for a quick setup, with the 835 data upload process taking just a few seconds. By employing the standard 835 data set, organizations can effortlessly upload relevant information with very little need for IT support. This platform capitalizes on existing data to provide insightful reporting on denials, emerging trends, and activities of individual payers. Such insights are crucial for pinpointing specific workflow requirements. Additionally, users will find the data querying feature straightforward, and they can conveniently save common queries for future use. For instance, analyzing denials based on remark codes and departmental performance can help uncover and address underlying issues effectively. Ultimately, Remittance360 empowers organizations to enhance their revenue cycle management by enabling informed decision-making and targeted improvements.

Experience the advantages of seamless hosting and unique integrated features through a mobile OPIE platform, enhancing your practice management software. This essential tool is indispensable for every O&P business owner looking to monitor various trends, from patient satisfaction metrics to comprehensive financial reports. Gain valuable insights into the duration of patient care episodes while discovering strategies to minimize errors and optimize cash flow. Visualize each step of the payment procedure and delve into detailed information to refine your processes for insurance verification and authorization. By adhering to the OPIE Workflow, you establish a systematic approach to your operations, beginning with the collection of patient information and the specification of L-codes, extending through product ordering and the electronic submission of claims for billing. Ultimately, embracing this structured workflow not only enhances efficiency but also contributes significantly to overall practice management success.

Empower your front desk team with the flexibility required to facilitate seamless patient visits throughout the entire appointment process. With MicroMD’s Practice Management scheduling tools, you can efficiently handle your busy day with ease and accuracy. Find available time slots effortlessly based on patient requirements and staff schedules, while also adding notes and categorizing appointments. Advanced waiting lists intelligently align the appropriate duration, physician, time, and location to enhance both productivity and patient contentment. Utilize template-driven layouts to display appointment schedules by week, day, location, and provider, ensuring clarity and organization. The incorporation of color-coded views, designated time slots, and recurring schedules streamlines the scheduling experience. Additionally, patients can conveniently book appointments or submit requests via the Henry Schein Secure Chart Patient Portal, allowing those with accounts to log in and instantly view available times with various providers to secure their appointments. This level of accessibility not only improves patient engagement but also optimizes the overall efficiency of your practice.

The FINEOS Platform stands out as the sole comprehensive end-to-end SaaS core product suite for clients, featuring FINEOS AdminSuite for managing everything from quote to claim, alongside add-on products such as FINEOS Engage to enhance digital interaction, and FINEOS Insight for advanced analytics and reporting capabilities. It serves as a cornerstone for your digital insurance approach. By integrating FINEOS AdminSuite, FINEOS Engage, FINEOS Insight, and robust platform capabilities, the FINEOS Platform establishes itself as the most contemporary single core insurance solution tailored for Life, Accident, and Health sectors. In contrast to outdated legacy core systems that relied on a 'one size fits all' technology model, which is no longer suitable for dynamic businesses, modern consumers, employers, and brokers now benefit from sophisticated SaaS solutions and software that elevate expectations for an insurer's digital initiatives. The previous monolithic insurance software systems primarily concentrated on the intricacies of insurance contracts, overlooking the need for flexibility and adaptability in today's fast-paced market. Embracing the FINEOS Platform means adopting a future-ready approach that aligns with current consumer demands and technological advancements.

EMCsoft's Claims Management Ecosystem guarantees that healthcare providers and billing companies submit accurate claims to insurance payers for effective claim processing. This system combines our adaptable claims processing software, Claim Agent, with a comprehensive methodology known as the Four Step Methodology, seamlessly integrating into your claim adjudication workflow. By implementing this strategy, we enhance, facilitate, and automate your processes to optimize claim reimbursements. For an insightful overview of Claim Agent's features and its integration into your claims process, you can request our complimentary online demonstration. Claim Agent efficiently manages the scrubbing and processing of claims, ensuring a smooth transition from provider systems to insurance payers in a timely and cost-effective manner. The software is designed to be compatible with any existing system, ensuring a swift and straightforward implementation. Furthermore, we offer tailored edits, bridge routines, payer lists, and workflow configurations that cater specifically to each user's requirements, enhancing the overall claims management experience. This personalized approach enables healthcare providers to focus more on patient care while we take care of the complexities of claims processing.

Utilize a cloud-based healthcare delivery system to effectively manage your members' healthcare and networks. This system streamlines the claims processing for managed care organizations by automating various tasks such as eligibility verification, referral and authorization handling, provider contracting, benefit management, auto adjudication of claims, capitation for primary care and specialty services, EOB/EFT check processing, as well as EDI transfers and reporting. It can be implemented as a cloud solution or operated in-house, making it suitable for a range of entities including managed care organizations (MCOs), independent physician associations (IPAs), third-party administrators (TPAs), preferred provider organizations (PPOs), and self-insured groups. By simplifying the intricate processes involved in managing eligibility, referral authorizations, and claims, this system enhances operational efficiency. Its features are designed to optimize data integrity while minimizing the need for manual data entry, thus improving overall accuracy and productivity. Additionally, the flexibility of deployment options ensures that organizations can choose the best fit for their operational needs.

This powerful tool allows you to practice medicine anywhere and anytime. The athenaOne mobile application allows you to do meaningful clinical work wherever and whenever you want. Access patient records to create and sign orders, respond and prepare for exams, and to document them. The app allows you to catch up on work or get ahead of it during your free time. You can log in to the app with touch or face ID to see a quick overview of your day. You can view your schedule, see the patients you have prepared for, and manage your inbox. With customizable patient summaries, it takes just a few minutes to get up-to date on the patient's history. To review all that has happened since their last visit, you can access full charts. Access the clinical inbox for critical work from anywhere and at any time. AthenaClinicals makes it easy to create and sign orders, view test results and respond to patient cases.

Reduce administrative hours by 20% for your practice while verifying patient insurance eligibility instantly and enhancing the check-in experience with our kiosks, tablets, and software solutions. Make the check-in process easier for patients by enabling them to register before their appointments from any location at their convenience. The registration procedure is made simpler, and the intake process becomes more efficient. With our flexible workflow, you can expedite the check-in process, achieving an average of just 3 minutes for new patients and under a minute for returning ones. This not only accelerates patient processing but also boosts successful payments and enhances cash flow within your practice. Medical facilities have reported increases in their point-of-sale collections ranging from 25% to 65%. Clearwave addresses the issue of patient impatience effectively. By implementing a digital front door that remains accessible at all times, you can ensure seamless scheduling, automated eligibility checks, efficient patient check-in, and clear financial transparency for everyone involved. This innovative approach transforms the patient experience and ultimately leads to higher satisfaction rates.

The Talix platform facilitates advanced workflow applications designed for risk-bearing healthcare organizations to thrive in a value-based care environment. Our solutions for both payers and providers depend on sophisticated technologies that operate seamlessly and efficiently across large scales. We have developed the Talix Platform to accommodate the requirements of thousands of users globally, ensuring simultaneous access. Additionally, our architectural design supports a variety of SaaS applications, optimizing the processing of millions of patient records and encounter data. The Talix Platform consists of a network of interconnected technology components, which are essential for driving scalable software solutions for healthcare providers and payers. These components serve as foundational elements for artificial intelligence (AI), enhancing the platform's capabilities and effectiveness in the healthcare sector. Ultimately, the integration of these technologies positions the Talix Platform as a leader in the evolution of healthcare workflows.

Alaffia utilizes an advanced AI system that identifies instances of fraud, waste, and abuse within complex healthcare claims, aiming to prevent and recoup overpayments for both payers and employers alike. This innovative approach allows Alaffia to spot and rectify inaccuracies in misbilled claims prior to any erroneous payments being executed. By collaborating with Alaffia, you can reclaim funds lost due to overpayments on these incorrect claims, which may be costing your organization significant amounts each year, potentially hundreds of dollars per employee. Partnering with Alaffia means you can effectively reduce these overpayments and enhance your financial outcomes. The Alaffia platform is adept at detecting and amending improperly billed claims, which helps in averting unnecessary overpayments. Our collaboration with your health plan or third-party administrator ensures a smooth integration process that does not disrupt your members' experience. Additionally, our services operate on a contingency basis, meaning you only incur costs when we successfully achieve savings. We are committed to safeguarding your employees from being charged for services that were never provided, ensuring financial integrity in your healthcare expenditures. With Alaffia, you not only save money but also enhance the overall efficiency of your claims management process.

Anagram Prosper returns funds to your patients without any expense to your practice, enhancing your profit margins while ensuring patient satisfaction, eliminating the need for courtesy discounts. We've collaborated with top vendors to create wholesale pricing that caters to the needs of both you and your clientele. This allows you to offer rebates on products you already have in stock, encouraging your patients to engage more, ultimately leading to increased revenue. By utilizing Anagram Prosper, you can help your patients save without cutting into your margins or providing discounts. Our rebate program is designed to boost your sales while keeping your patients content. Many patients are unaware of their out-of-network benefits; however, Anagram Access can provide real-time eligibility for vision plans, ensuring the best savings for them. With Anagram Access, you can effortlessly determine your patient's financial responsibility and the reimbursement amount from their vision plan, streamlining the payment process. This innovative approach not only benefits your practice but also elevates the overall patient experience.

The CareEco Engine is an innovative, data-driven AI platform that meticulously reviews patient medical records in accordance with AMA guidelines to uncover potential care opportunities. Through automated communication via SMS or email, CareEco facilitates appointment scheduling directly from the patient's mobile device. This seamless process results in a higher number of booked appointments, enhanced patient health outcomes, improved experiences for patients, and increased revenue for healthcare practices. With its features that include automated messaging, an intuitive scheduling portal, and a secure payment gateway, CareEco empowers patients to efficiently book and pay for their appointments. Consequently, this allows your staff to devote more time to patient care rather than administrative tasks. By actively engaging with patients, CareEco ensures they remain within your healthcare network, while streamlined scheduling promotes easier access to essential medical services. In essence, CareEco revolutionizes the way patients interact with healthcare, making it more convenient and accessible than ever before.

By conducting comprehensive assessments of patients' financial qualifications, analyzing their insurance coverage, and identifying any inconsistencies, the eligibility checker ensures thorough evaluation. Should any inaccuracies arise in the submitted data, our advanced scrubber utilizes deep AI and ML algorithms to rectify issues, including coding mistakes and incomplete or incorrect financial details. Currently, the software boasts an impressive repository of 3.5 million pre-loaded edits to enhance its functionality. To optimize workflow, automatic updates from the clearing house provide real-time information regarding the status of pending claims. This system encompasses the entire billing process, from validating patient financial data to addressing denied or lost claims, and includes a robust follow-up mechanism for appeals. Moreover, our user-friendly platform proactively alerts users to potential claim denials, enabling timely corrective measures, while also effectively tracking and managing appeals for any claims that may have been lost or denied. The seamless integration of these features reinforces the system's effectiveness in handling the complexities of medical billing.

Our platform fosters consistency, continuity, and scalability throughout our interconnected portfolio, allowing customers to enhance their operational efficiency, make informed decisions, and achieve better patient outcomes while driving innovation in our evolving healthcare system. By leveraging advanced data and analytics alongside patient engagement and collaboration tools, the Change Healthcare platform empowers both providers and payers to streamline workflows, obtain the necessary information precisely when needed, and ensure the delivery of the safest and most appropriate clinical care possible. We facilitate seamless access to data and promote interoperability among various data sources, thereby supporting CMS patient access and interoperability regulations, which ultimately leads to real-time access to clinical documents. This approach is instrumental in managing risk adjustment effectively, boosting HEDIS scores, and ensuring timely and precise payments through quicker adjudication. Furthermore, our commitment to innovation positions us to adapt to the changing landscape of healthcare while continually improving the services we offer.

EzyMed Online 4 serves as a complete Medical Practice Management solution tailored for General Practices, Radiology, and Specialist Centres in Australia. Specifically designed for the unique needs of the Australian healthcare landscape, it offers all the necessary features to facilitate Medicare Australia’s Online Claiming, as well as Department of Veterans Affairs (DVA) Claims and Australian Childhood Immunisation Register (ACIR) claims. This integrated system allows for efficient management of your practice with minimal effort, streamlining operations through user-friendly navigation. It employs a secure database management system, ensuring optimal performance and reliability even when handling vast amounts of data, including over a million records. Once a patient registers at the reception, EzyMed Online 4 meticulously tracks the consultation process, storing all information in a digital format within the patient’s database. This enables healthcare providers to access a comprehensive medical history at any time, including records of every appointment ever logged, thereby enhancing continuity of care and service quality. In summary, EzyMed Online 4 not only simplifies administrative tasks but also boosts the overall efficiency of medical practices.

E-COMB, or EDI Compatible Medical Billing, serves as a web-based platform designed to create medical claims that adhere to the HIPAA transaction and code set standards mandated by the US Government in accordance with the guidelines established by the American National Standards Institute (ANSI). This solution facilitates the generation, submission, and reconciliation of claims directed towards insurance companies, guarantors, and patients, making it an essential resource for healthcare providers to optimize their revenue by significantly shortening the claims reimbursement process. Additionally, all pertinent information related to the operational context of a Doctor’s Office or Hospital is compiled as Master Data, which is often utilized for claims processing and tends to remain stable over time. This Master Data encompasses critical details regarding Procedures, Diagnoses, Doctors, Payers, and Billing Providers, among others, and is initially created during the setup phase, with the flexibility for updates as necessary. Consequently, E-COMB not only streamlines the billing procedure but also ensures that healthcare professionals have easy access to the most current and relevant information for their operations.