Best Web-Based Healthcare Payer Care Management Workflow Applications of 2024

Many doctors who could refer them to your home health services aren't aware of the patients who need them. This is likely because your sales and marketing teams don't see 75% of Medicare claims related to office visits. Demonstrate your ability reduce costs and improve patient outcomes. Home Health Agency A can quickly show how it performs better than Home Health Agency B in terms of hospitalization and readmission rates. Marketscape for Home Health allows you to redefine your marketing and sales strategy in order to focus on high-potential facility and physician referral sources. Our innovative technology and support allow you to quickly evaluate how you rank against your peers in terms of hospital and readmission rates as well as diagnostic category, acuity level and time to care.

Health Catalyst, a leader in data and analytics technology for healthcare organizations, is committed to being the catalyst of massive, measurable, data informed healthcare improvement.

It is an important mission to provide compassionate, high-quality care in rural and other critical access areas. Your patients look up to you at every stage of their lives. As the only provider in your community, you must be available with the right information and tools to make a difference. Paragon, an integrated ambulatory and acute electronic health record (EHR), is ideal for rural and community hospital IDNs and single IDNs. Paragon provides clinicians with clinical information and decision support tools right at the point-of-care, improving their satisfaction. Paragon offers workflow intelligence guides that enable clinicians to quickly locate patient information and present the right information at the appropriate time for better efficiency and care delivery. Paragon users have a track record of helping them stay ahead of healthcare reform, regulatory mandates, pay for performance, and other realities in today's changing healthcare system.

Connecting healthcare organizations and streamlining interoperability for improved outcomes and operations. The Infor Cloverleaf®, Integration Suite software facilitates the exchange and management of clinical data, which can help improve healthcare outcomes as well as business operations. The software allows healthcare organizations solve complex interoperability problems securely and at scale using the most recent standards (including FHIR®, HL7®, etc). Cloverleaf is the clinical integration platform for healthcare providers, ACOs and laboratories, as well as application and medical device manufacturers (ISVs) and OEMs. The platform supports virtualization for private or public cloud implementations and leverages the best fail-over and availability mechanisms. Cloverleaf scales to accommodate healthcare organizations of all sizes, while offering multiple options for interoperability architectures.

CORTEX, a new category of utilization software, offers a 360deg approach for addressing the intricacies revenue cycle and utilization management. CORTEX is powered by real-time predictive analytics, machine learning engine, and ensures that the right cases get handled at the right moment, by the right staff, or by exception. CORTEX integrates precision medicine on the basis of evidence-based medicine. Machine learning models are able to assess your patient population in real-time. Our analytics have been used in hospitals and health plans across America. CORTEX automates inpatient determinations for cases that meet your specific threshold, providing clear inpatient cases. CORTEX gives your staff the information they need to make a solid determination in difficult cases. This approach is a great value for both payers and providers.

Mosaic gives you unparalleled visibility into market-wide performance metrics for all provider types. This allows you to evaluate risk before you take it on and optimize relationships to thrive in today's value-based healthcare landscape. You can't build and maintain a winning network if you have an underperforming partner. Find out what you can do to close the gaps and take advantage of opportunities. Specific goals can be achieved, such as the creation of preferred provider groups or adding provider types. Collaborate with providers in order to improve quality, utilization, cost, and cost. Lower total cost of care and improve patient outcomes.

Fully managed platform uses best-in-class cloud technology to modernize the healthcare data ecosystem, ensure interoperability, lower total cost of ownership, and deliver scale and flexibility. Abacus Insights' customer-centric focus and concierge data management services reduce the need for change management. This allows you to concentrate on developing rich analytic capabilities that help you achieve your business objectives. The platform's Unified Data Foundation secures healthcare data quality by standardization. This allows for seamless distribution of on demand data to end-users. Experts in healthcare to improve the way your data is managed. This service accelerates the development of enterprise data warehouses, operational data stores, and data lakes. It also provides peace of mind with experts who can help business users.

Processing claims from Medicare, Medicaid, and all commercial payers will increase your company's cash flow. Automated processing of all payer claims from anywhere and at any time ensures that your claims are processed quickly and paid out. You can submit and track your claims automatically from anywhere with real-time status updates. A dedicated account manager is assigned to you, who is a certified healthcare claims manager. You even have their mobile number. Our automated, anytime, anywhere claims process allows you to diversify your revenue streams and improve your cashflow. You have complete visibility to all electronic funds transfers (EFT) as well as payment projections. Track, process and fix claims in real time to maximize your revenue and eliminate costly, time-consuming processes. Automate Medicare eligibility verification, claims processing.

AyusLab, a cloud-based LIMS software, was created to encourage diagnostic business through better customer engagement, quality control, and faster service. This LIMS software has been designed to increase revenue and provide quality service. It is a LIMS platform that allows you to retain loyal customers and accelerate your business. You can also use its business intelligence to plan, analyze, and improve your lab-based operations every day. AyusLab LIMS allows you to quickly analyze and view your business performance in real-time. You will also have a detailed view of your finances, billing, receipts, and other information. It also allows you to monitor your quality control, inventory and NABL compliance.

Acuity Advanced Care™ is a population health platform on-premise that supports the specific needs of programs for managing population health, utilization, diseases, and cases. The system is configurable and allows organizations to take full control of their environment. Over 90% of Acuity Advanced's clients are NCQA, URAC or both accredited. Acuity Advanced Care offers the flexibility of on-premise and full database access. On-premise installation allows you to control where your data is stored. Customers with IT teams who are experienced in the setup, security, and maintenance complex systems. Chordline Health, the leading provider of health plan software, TPAs and ACOs as well as other risk-bearing organisations, is the leader in this field. The US-based Chordline team is recognized for its best-in class managed care expertise and excellent customer service.

CoverSelf’s healthcare-specific next-gen cloud-native and customizable claims accuracy platform was built from the ground-up using modern software development methods. It enables users to achieve long-term success through its ability to adapt to dynamic, ever-changing claims and payment inaccuracies while reducing administrative costs and complexities. This platform gives all partners who are working to reduce claims inaccuracies and administrative waste access, allowing them to build, customize, innovate & release faster. CoverSelf's Payment Integrity Platform uses modern technologies to address payment inaccuracies & leakage while remaining transparent and accessible to payers. This platform is designed to accelerate innovation and create new scenarios and data mining algorithms. It also helps innovating products and expediting customization. Claims are automatically corrected and processed, so there is no need for additional human effort or intervention.

symplr's provider credentialing software creates a single source for data on providers, reduces turnaround times and shortens revenue cycle, all while prioritizing the safety of patients. Symplr's Provider Credentialing Software makes data collection, secure access, report generation, and ongoing compliance easier for providers, credentialing personnel, and internal approval panels. Our customers report a reduction of 20% in credentialing timelines and a 50% reduction in meetings with committees. In one automated, user friendly hub, you can collect, verify, store and share documents and data related to the provider lifecycle. This will save time and reduce costs. You can easily enroll payers with providers and track applications step-bystep using the built-in module. Automate the collection of data from hundreds primary sources, including DEA, SAM and NPDB.

Accelerate payment and reduce administrative burdens. Our claims management solutions, which have a network of 8,000+ payers and a long-standing partnership with 650+ practice managers, can lead to fewer pending cases and less manual intervention. Transmit professional, institutional dental, workers compensation, and other claims quickly and accurately for fast reimbursement. Provide a simple and seamless financial experience to meet the shift towards healthcare consumerism. Our patient engagement solutions enable you to have informed discussions about eligibility and financial responsibility, while reducing obstacles that could impact patient outcomes.

LGI RPA, formerly Boston WorkStation, helps hospitals and health systems fill the gaps left behind by system vendors that don't deliver interoperability promises. This leaves providers and staff struggling with time-consuming manual processes. It is a flexible client-to-client solution that can be configured to fit your workflow and business constraints. It's time for you to look at your processes and bottlenecks and consider how you can automate them. LGI RPA, formerly Boston WorkStation, is a digital assistant that works alongside humans 24/7/365 to complete tasks, ensure accuracy, and eliminate the workflow issues caused by manual data entry. It's more than just an automation tool. It's also a workflow improvement system that identifies errors and prevents them from happening.

The GuidingCare suite of solutions provides easy-to use, next-generation tools for data integration and workflows management that will help you operationalize a person-centered, evidence-based Care Management strategy. Its sophisticated data analysis, workflow management, reporting, and care coordination capabilities allow your organization to better serve and maintain compliance with targeted populations. GuidingCare allows you to streamline coordination across care spectrums, manage clinical and behavioral needs, automate service planning and care, and identify high-risk populations. Drive superior outcomes with a fully integrated, value-based and patient-centric ecosystem.

Clarity Multi Medical is a SaaS-based technology that enables companies to work more efficiently and scale up at lower costs. Clarity's business process reengineering delivers automation, streamlining and process control, which translates to less administration and fewer managers needed for each new site. Clarity Multi Medical is a powerful technology backbone that can be used across the business. Staff can focus on building strong relationships and improving patient outcomes when technology is supporting the business. Clarity Multi Medical is not just a great piece of software; it's also backed by a team of highly experienced and passionate professionals. Our team includes Implementation specialists, Trainers who have industry experience, as well as Strategy Consultants. They will guide you in how to configure and use Clarity Software to best suit your business environment.

You can easily get an overview of all your clients using a user-friendly dashboard that includes encounters and core service encounters. It also includes segments, claims and billable statuses. Care Managers are able to track progress when addressing gaps within member care. Link these files to care plans directly for efficient tracking and report. Send data from claims and documentation directly to MAPP HHTS. Enjoy the best-in class MAPP sync, and customer support. The system will automatically handle Health Home billing requirements, allowing you to generate CMA statements and claims quickly. If HML rate codes are changed, void and re-submit the claim. Use the logic built into HMLs to complete HMLs that meet the required number of core services and face-to-face meetings, as well as other requirements. Attend roundtables to discuss our product roadmap with other customers and emerging Health Home requirements. We check in regularly with our customers to understand their specific needs.

I.C.E. has been a leader in the support of paperless information systems. Apple™, as hundreds of our customers believe, is a key software in hospital management information systems. Customers have reported that their patient care, productivity and profitability has improved after using the software. We will help you create EMR/EHR solutions, practice management software and laboratory management systems, hospital-wide asset-tracking systems, point-of-care (POC) tools and population health management (PHM), AI-powered data eco-systems, and applications for remote patient monitoring. We use the latest frameworks to create user-friendly, secure, scalable and new business solutions that meet your needs. We have a team of developers that are experienced in delivering high-end solutions using several frameworks and technology.

Our decades of RTLS experience, which comes from our roots at Versus Technology, is unmatched. Our expertise in easy-to use solutions, backed by the strength of Midmark Corporation empowers a more positive care experience. Discover how efficient your facility is, how safe it is and how engaged staff are by using RTLS solutions. These solutions allow staff to focus on the most important thing: patient care. Nurses can save time by cancelling calls automatically. Wearable duress buttons that trigger a critical response in the fight against workplace violence. Tracking of healthcare equipment to assist staff in providing safe equipment and timely patient care. Healthy workflows that support both staff and patient satisfaction.

The software ensures high performance in hospital administration and provides support to all sectors. It reduces costs and standardizes processes. By optimizing the scheduling flow, the software reduces absenteeism in appointments and testing. Reduces the risk of medical errors by providing quick and easy access to patient information and history. Automates processes to ensure greater efficiency in managing workflows and resource administration. It ensures that the right purchasing cycle is followed, preventing waste of drugs, equipment or services. Information can be accessed on different devices and offers mobility in the care of the patient. It facilitates the extract conciliation and reduces the disallowance indices.

Many health plans and PBMs use multiple systems. These information silos can limit the quality of care, and present significant challenges in terms of compliance and process. MHK CareProminence is designed to bring all the functionality and vital information across the member's healthcare journey together into a single system. MHK CareProminence is the only platform that combines pharmacy with medical. It was designed to improve member care, by closing care gaps and ensuring compliance with ever-changing regulatory requirements. Clients enjoy the most rigorous system available in the industry, and the manual effort is significantly reduced. MHK CareProminence helps customers to maximize efficiency through automated workflows. They can also increase compliance, improve quality scores, engage members and providers, and optimize their healthcare experience.

unisonMD helps your doctors and billing staff manage hospital charges faster and easier. Our customers see measurable improvements in financial performance, care coordination efficiency and productivity, as well as provider and staff satisfaction. unisonMD optimizes the revenue cycle of hospital and out-of office patient encounters. Our customers report that they achieve better financial results, increased productivity and high user satisfaction. HIPAA-compliant messaging saves time and protects health information.

We believe that technology and healthcare domain experts are essential to improving clinical and operational efficiencies. Our Nuvola Hub Healthcare Integr Platform as a service (Hi-PaaS), combined with our team of healthcare integration specialists, provides our clients with world-class support and unparalleled service. This allows us to continue to be a leader in healthcare connectivity. Express is a fully managed integration service that doesn't require you to hire integration experts or pay for integration engine software. Express is a fully managed service for integration. Iron Bridge believes in transparent pricing that is fair and affordable for its customers. This allows us to offer a high quality service level. No Interface Engines required. Express integrates with EHRs and Labs.

Wambi is the difference. It uses the real-time patient voice and inspires others to improve healthcare experiences. Our SaaS solution is fully configurable and helps increase employee engagement, decrease clinician burnout, improve patient satisfaction, and reduce clinician burnout. Play Moments Move Us, the official podcast of Wambi. Take a moment to reflect on your own experiences of authentic connection with Rebecca Metter, CEO at Wambi. You will also hear the stories of extraordinary leaders and the moments that inspired them. Healthcare executives can increase team member engagement, reduce clinician burnout, and support your workforce strategy to achieve data-driven impact. To feel valued at work and realize their contribution, staff members can share and receive personalized, real-time recognition from their peers, leaders, patients and their families.

It is a comprehensive web-based, browser-based hospital management information system software solution. It is available in English and Arabic versions. It covers all aspects of healthcare organization management and operations according to international standards. PrimeCare is a modular web-based software system that includes more than 70 modules (Administrative as well as Medical). Our health care products are currently used in more than 100 hospitals. PrimeCare, a comprehensive web-based, browser-based hospital management information system software solution that covers all aspects of healthcare organization management according to internationally recognized standards, is available in English and Arabic versions.