ClaimAdept Description
This solution provides a comprehensive claims management system from start to finish. Its main capabilities include processing claim adjudications, managing claim workflows, and facilitating payment distributions. With a versatile architecture, it allows for the integration of adjudication modules tailored to specific lines of business, ensuring that each new addition capitalizes on the system's core functionalities. The user-friendly interface, designed for Windows, leverages a relational database for efficient information storage. Built on the Powerbuilder software platform, it utilizes SQL databases like Oracle or Sybase, making it well-suited for a client-server environment that can handle significant claim volumes. Additionally, both installation and training services are offered, and the licensing package includes the source code. Furthermore, a team of experienced professionals is available to customize and adapt the system according to any unique client needs. All changes come with thorough design documentation and support for the acceptance testing process, guaranteeing a seamless integration experience. This ensures that clients receive a tailored solution that effectively addresses their specific requirements.
ClaimAdept Alternatives
Service Center by Office Ally is trusted by more than 80,000 healthcare providers and health services organizations to help them take complete control of their revenue cycle. Service Center can verify patient eligibility and benefits, submit, correct, and check claims status online, and receive remittance advice. Accepting standard ANSI formats, data entry, and pipe-delimited formats, Service Center helps streamline administrative tasks and create more efficient workflows for providers.
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Macaw AMS can be used to sell Insurance. Macaw AMS can be used by brokers, MGAs or MGUs, Program Managers, and Lloyds Coverholders to automate their operations.
Macaw AMS was built with a customer-centric approach. It supports CRM, Sales and Underwriting. Customers, producers, and service providers can access self-service portals.
Macaw AMS has built-in Document Management and Task Management capabilities. It is equipped with adaptors that allow for integrated and in-flow services such as eSignature, Payments, OFAC checks, Mass Emailing, Computer Telephony, and Mass Emailing, using 3rd Party Services.
The data analytics part of Macaw AMS offers powerful data visualization with predefined dashboards, allowing users to easily upload datasets and view dynamic charts for clear, multi-dimensional insights. Interactive, real-time visualizations help uncover trends and insights, driving informed decision-making.
Macaw AMS is hosted on cloud and tested for cybersecurity. The database is relational, and the core components of the Java-based application are written in Java. Macaw AMS is capable of processing 500-1000 policies per day at its peak.
Macaw AMS is expected reduce per policy costs by 30%.
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Complete Claims
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.
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Cloud Claims
APP Tech pioneered the incident-based approach to claims and risk management. Since 2003, we’ve delivered integrated technology solutions to hundreds of customers across North America — to improve claims-management efficiency and scalability, increase visibility, shorten response times, lower premiums, and prevent risk events.
Cloud Claims by APP Tech is a top-rated risk management and claims software solution. IMS is a purpose-built software solution for self-insureds, TPAs, and companies who want to track their claims and losses. It helps users manage the entire claim lifecycle, from the initial incident report to issuing payments and collections. It offers a variety of features that allow users to have complete control over their claims, as well as risk information. These include incident management and claims management, workgroup tools as well as reporting, insurance tracking, and many other features.
We’re proud of our 100 percent implementation-success rate and excellent customer-retention rate, a result of our commitment to understanding our clients’ needs and rolling out solutions that work for them.
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Integrations
Company Details
Company:
Isoft
Year Founded:
1985
Headquarters:
Canada
Website:
pages.interlog.com/~paustin/products.htm
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Product Details
Platforms
Web-Based
Types of Training
Training Docs
Customer Support
Online Support
ClaimAdept Features and Options
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