Alternatives to Context 4 Health Plans Suite

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.

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.

XpertCoding by XpertDox is an AI medical coding software that utilizes advanced artificial intelligence, machine learning, and natural language processing (NLP) to automatically code medical claims within 24 hours. This software streamlines and enhances the coding process, ensuring faster and more accurate claim submissions and maximizing financial returns for healthcare organizations. Features include a comprehensive coding audit trail, minimal need for human supervision, a clinical documentation improvement module, seamless integration with EHR systems, a business intelligence platform, a flexible cost structure, significant reduction in claim denials and coding costs, and risk-free implementation with no initial fee and a free first month. XpertCoding's automated coding software ensures timely payments for healthcare providers & organizations, accelerating the revenue cycle and allowing them to focus on patient care. Choose XpertCoding for reliable, efficient, and precise medical coding tailored to your practice.

AZZLY Rize is the premier clinical and business platform for addiction treatment and mental health organizations. As a modern technology platform, AZZLY Rize is a system that can scale with you. Use as little or as many of the features and functions available based on your program and staff needs. Key features for OUTPATIENT Programs include e-check-in, scheduling, appointment reminder, Zoom telehealth, treatment plans, progress notes, assessments and surveys. For RESIDENTIAL Programs: census, medication management, bed board, withdrawal management, DrFirst e-prescribing, EPCS, PDMP and labs. For all Programs: alerts, patient engagement, 5 star implementation and support services, and seamless electronic billing and claims submission. As a true all-in-one platform, we empower treatment centers to take control of their compliance and revenue cycle management and reporting requirements. As a purpose-built tool for mental health and substance use disorder programs, we offer a flexible pricing plan to replace dated technology. Use our compliant Master Library of Forms or we configure your documentation forms to match what you use today. Hosted in Microsoft Azure Private Cloud Network for added security and HIPAA privacy.

Parascript software automates mortgage and loan document processing faster and more accurately. It also automates insurance document-based tasks that allow for the intake and review of healthcare insurance data. Document processing automation automates the process of processing documents to improve efficiency, data accuracy, and reduce costs. Parascript software is driven by data science and powered by machine learning. It configures and optimizes itself for automating simple and complex document-oriented tasks like document classification, document separation, and data entry for payments and lending. Parascript software processes over 100 billion documents each year in the areas of banking, government, insurance, and other related fields.

Guidewire ClaimCenter, a leading claims-management system, is designed to streamline all aspects of the claims lifecycle. It provides comprehensive functionality, from the initial claim intake through to resolution. This allows insurers to process their claims efficiently and accurately. The key features include automated workflows and embedded analytics, integrated Fraud detection, and real time performance monitoring. These all improve operational efficiency and customer satisfaction. ClaimCenter is compatible with a variety of insurance lines, including personal, workers' compensation, commercial and business. It can be used as a standalone application or as part the Guidewire InsuranceSuite. ClaimCenter allows insurers to accelerate claim processing, make data driven decisions, and adapt their business to changing market demands.

Virtual Examiner®, PCG Software’s flagship product, monitors an organization's internal claims process to track provider data for fraudulent or abusive billing patterns and maximizes financial recovery. The Virtual Examiner®, a PCG Software product, allows healthcare organizations to improve their claims adjudication system by allowing for more than 31,000,000 edits per claim. The software monitors an organization's internal claim process to identify and reduce payments for incorrect or erroneous code to save premium dollars. Virtual Examiner®, is more than a claims management solution that focuses on code combinations. It is a cost containment solution that evaluates the claim not only for abusive billing patterns but also identifies those claims that may involve third-party liability/coordination of benefits, case management opportunities, physician billing education and many other cost recovery reports.

Automated end to end claims platform with AI models for data acquisition and policy & coverage checking, medical coding and consistency checks. Our AI-based models detect fraud, abuse, and waste to reduce leakage and improve loss ratios. Qantev improves the performance of life and health insurers around the world, helping them to reduce losses, optimize processes, and increase customer satisfaction. Our team of data scientists and engineers have developed innovative solutions by combining artificial intelligence and medical expertise. These solutions boost the claims management process, uncover fraud, waste and abuse, and improve client satisfaction. AI-driven tools that are contextually specialized to digitize, clean, enrich, and capture data from any claims document in any language. Improve the performance of your medical provider network through automated AI-driven insights, pricing gap detection and strategy recommendations.

Duck Creek Claims, a comprehensive solution for claims management, is designed to streamline the claims lifecycle. It automates workflows and simplifies data analysis with integrated analytics. It also ensures seamless integration of existing systems. The key features include dynamic first-notice-of-loss (FNOL) capabilities. They also include automated assignment based upon adjuster skills and workload. Instant access to policy and coverage information is also available. Duck Creek Claims improves operational efficiency by reducing manual workloads. This leads to faster claims resolutions, improved customer satisfaction and compliance with latest regulations.

Imagine happy, efficient claim handlers, fast, accurate claims resolution, and 5-star rating from policyholders. Our platform is flexible and future-ready, enabling your employees to perform like rockstars and equipping your company with scalable, intuitive processes that will fuel profitable growth. Our clients can reduce the cost of claims by up to 30% by automating and simplifying the process. VCA Software is a highly scalable and integrated platform. VCA Software is a favorite among TPAs as well as adjusting firms due to its robust features at a moderate price point.

Accelerate your scoping, estimation, and cycle time. Create 360deg 360deg photo tours with detailed 3D in less than 20 seconds per room. Floor plans can be generated in as little as 5 hours. With just a few taps on your smartphone, you can get scope of work reports. Estimates that are compliant with insurance can improve your bottom line. You will find everything you need to accurately document, sketch and scope your estimate. Low upfront costs with maximum time savings, and most bottom line improvements. No complex onboarding or training required. Pick it up and get started. A team of professionals is available to help you, including a 24-hour hotline. Our camera is more accurate and has a smaller margin of error than a phone. Years of industry insight fuel our products, and propel your business to the next level. DocuSketch transforms the restoration industry with cutting-edge software, reducing cycle time, increasing profitability, and expediting claim processing to drive growth and assist.

AUSIS (Full-stack Behavioral underwriting) AUSIS allows insurance companies to offer in-depth underwriting, scoring and decisions in real time. AUSIS reduces cost, time, risk, fraud, and increases efficiency, decision power, alternative score, and more. AUSIS increases STP from NSTP. It also allows non-invasive methods to aggregate health data from AQI and Location, Mortality and Social, Photo, Video and Health Devices. Weather, Sanitation, and more. AUSIS can reduce the policy issuance cost by up to 40%

Claims adjudication for short- and long-term disability claims. Available as an on-site license (ASP) or as a hosted app (ASP). Microsoft technology: SQLServer database with Windows front end. Highly acclaimed Customer service, staffed by experts in health care claims with at least 12 years of experience in the field. Support calls are recorded and status is available online. Plans can be copied and modified quickly using the plan modification feature. Auto-adjudication with benefit codes built using business principles based on more than 25 variables from the claimant and claim records that were made available to the adjudication engines. Inbound claims can either be scanned images or EDI. HIPPA EDI-5010 transaction sets. The system can be loaded with UCR Schedules and re-pricing fees in advance of the effective date. The date-driven logic will reprice based on the date service was rendered.

Virtual Benefits Administrator (VBA), the industry's best cloud-based benefits administration solution, is VBA. VBA offers a wide range of functionality and flexibility that allows users to manage their medical, vision, and dental care.

Filing claims is a complex and crucial process. Because of its complexity and time-consuming nature, more than 60% of people don't file complex claims. Artivatic's dedicated claims platform allows insurance companies to facilitate digital claims journeys, self claims processing, automated risk assessment, fraud intelligence, claims payout, and self-claims processing. ALL YOUR CLAIMS NEEDS CAN BE MET IN ONE PLATFORM. End to End Claims Automation and Assessment Platform AUTO CLAIMS – HEALTH CLAIMS – TRAVEL CLAIMS – ACCIDENTAL ClAIMS ­ DEATH CLAIMS – FIRE CLAIMS SME CLAIMS — BUSINESS CLAIMS ­ COMMERCIALCLAIMS

Curacel's AI-powered platform allows insurers to track fraud and automatically process claims. You can easily collect your claims from your Providers and auto-vet them. Curacel Detection can help you identify and curb fraud, waste, and abuse in the Claims Process. Collect claims from providers to prevent fraud, waste, and abuse in the claims process. To understand where Insurers are losing the most value, we studied the Health Insurance industry. This was the Claims Process. The Claims Process is mostly manual and is prone to fraud, waste, and abuse. Our AI-driven solution helps reduce wastage and makes the Insurer more efficient, unlocking hidden value. Ravel insurance is unique in that it is built upon on-demand policies that only cover a short time. Both the policy holder and the insured want a fast and accurate claim settlement.

LexisNexis®, MarketView™, provides medical claims-based information to healthcare payers and providers, life science companies, and health IT organizations throughout the United States. MarketView provides actionable insights that help businesses remain competitive. It allows them to see valuable insights and visualize ways to transform their business. MarketView is available to all life sciences companies, health plans, health systems, and vendors. It can transform key business work streams such as marketing, sales and strategic planning, physician outreach, physician relations, network optimization, market research, pricing, contracting and recruitment. To remain competitive, your business needs the most actionable insight. It can be difficult to pinpoint the right areas of focus if the picture isn't clear. MarketView provides insights into areas such as physician alignment strategies, referral patterns, physician referral patterns, quality of clinically integrated network, patient volumes, and more.

HEALTHsuite provides a comprehensive benefit management system and claims processing software solution for health plans that administer Medicare Advantage and Medicaid benefits. HEALTHsuite, a rules-based auto adjudication solution, automates all aspects of enrollment / eligibility and benefit administration, provider contracting / reimburse, premium billing, care management, claim adjudication, customer support, reporting, and more.

Easy web-based EMR that can be used for dental sleep medicine, TMD & oral surgery. It's quick and easy to get up and running quickly. DentalWriter creates your case of medical necessity and generates individualized SOAP reports. These reports are your ticket to medical reimbursement and physician referrals. DentalWriter intelligently crosses-codes dental to medical for accurate and easy medical billing. Your integrated billing service concierge will take care of the rest. DentalWriter Plus+ uses the intake and exam data to cross-code dental to medical and generate individual SOAP reports of medical necessity required for physician communication and medical reimbursement. You can increase productivity and market your TMD and dental sleep practice with just a click.

FINEOS Platform offers clients the only comprehensive SaaS core product suite. It includes FINEOS AdminSuite, which allows for quote to claim administration, as well as FINEOS Engage which supports digital engagement, and FINEOS Intelsight for analytics. Your digital insurance strategy's foundation. FINEOS Platform seamlessly combines FINEOS AdminSuite, FINEOS Engage, FINEOS Insight, and Platform Capabilities to create a modern, single-core insurance platform for Life, Accident, and Health. Legacy core systems used a single-size-fits-all approach to business technology that does not fit the needs of agile businesses. Consumers, brokers, and employers have access to powerful SaaS computing platforms, software tools, and a higher standard for digital strategy for insurers. The monolithic models of insurance software that were used in the past focused only on the details of the insurance contract.

Centauri Health Solutions, a healthcare technology and service company, is driven by the desire to make healthcare more efficient for our clients and provide compassionate support to those in need. Our software, powered by analytics, allows hospitals and health plans (Medicare and Medicaid, Exchange and Commercial), to manage their variable income through a custom-built workflow platform. Our tailored support for their members and patients gives them access to life-enhancing benefits. Our solutions include Risk Adjustment, Medical Record Retrieval and Medical Record Coding, Analytics, RAPS/EDPS Submissions, HEDIS®, and Stars Quality Program Management. Clinical Data Exchange, Eligibility, Enrollment, Eligibility, and Revenue Cycle Analytics. Referral Management & Analytics. Social Determinants of health.

Our AI-powered technology allows you to make fast and accurate decisions on claims, which will allow you to better serve customers. By adapting certain features, and data sources, our solution is configurable for all insurance lines, from motor and property to health and life. Sprout.ai delivers fast and accurate decisions on claims, no matter the industry. Our technology can extract all relevant information from any claim document, including handwritten notes, call transcripts, and prescriptions. The claim is validated using external data such as provider network policies, medication information, treatment codes and other data. It is then compared to policy documents. Deep learning AI algorithms determine the best next steps for a claim, and pair them with a clear explanation.

The vendor presents A1 Tracker as a robust and configurable risk management system that can be used standalone or in conjunction with other business segments within an organization. Risk Management & Threat Assessment: Register of risks to track risks at all levels within an organization. This includes entity, project, asset and contract, vendor, divisions, business units, regions, and more. Real-time risk reports and heat maps, dashboard metrics alerts & notifications. Contract Management Contract module to track all types of contracts with customers, vendors, employees, and customers. Claims & Incident Management Reporting on claims and incidents for any type of claim: injury, medical, customer, insurance or asset, liability, work comp, liability, etc. Certificates & Policies in Insurance: Policies & certificates for insurance tracking with reminders and renewals. For agencies & carriers policy management includes tracking clients.

Daisee develops technology to give you deep insight into the behavioural, emotional, and commercial dynamics of your customers. Daisee automatically scores all customer interactions using a digital quality scorecard that is the first of its kind. This automatically identifies quality assurance issues that need human intervention in areas such as compliance, communication, and conduct. Daisee allows you to see beyond words and uncover the emotion deep within your interactions. It reveals what your customers really think, feel, and are saying. Daisee is software that can be easily deployed across any telephony system and can help organisations immediately create business value. Globally Daisee is available in Australia, New Zealand, and the USA.

A risk management solution for property and casualty. All-in-one benchmarking and claims management system that simplifies claims-related processes and makes adjusters' lives more simple. TerraClaim provides two tools to simplify claims-related operations. These tools are powerful enough on their own, but even more so when combined. An innovative cross-industry data analytics and claims benchmarking solution that compares your claims performance to industry peers. This helps you set better goals, manage risk reserves, and improve claim outcomes. The world's best property and casualty claims management software that streamlines your internal processes, improves productivity, drives desired results, and prevents fraud.

AI Insurance is an AI-powered, modern, cloud-based insurance management platform that streamlines and automates workflows for program administrators, captives and third-party administrators. The platform consolidates multiple functions into a single user interface, including premium billing, policy issuance, signature, rating engine and data management. AI-backed automation is used for key features such as invoice auditing. Defense counsel invoices are parsed, audited and compared to guidelines to prevent unauthorized fees. The platform also offers indemnity predictions, which it claims to be 25% more accurate after a year's usage. It provides cost predictions and recommendations for claim.

Five Sigma was founded with the mission of enabling claims organizations to innovate. Five Sigma's suite of tools and platform for claims management is what Insurers require to adapt to the rapidly changing world. Our suite of Claims First Cloud-Native products and User-Centric products allows adjusters to better manage claims and do so much faster. Automating administrative tasks allows adjusters to focus on making the right decision, while the system takes care everything else. The complete suite of claims management tools, including an in-system omnichannel communication platform, automated documentation and workflows, reporting, and open APIs. The state-of-the-art claims management platform allows you to go live in just weeks. Five Sigma's unique SaaS offerings, agile methodology, and weekly upgrades make it possible for carriers to improve their claims operations.

FileTrac is the #1 claims management software in the industry. FileTrac Evolve builds on this reputation. This enhanced version is an integral part of the Evolve Suite - a comprehensive platform that revolutionizes your claims management process. FileTrac Evolve, a leading web based claims management system, is designed for independent adjusters and third-party administrators. It also works with managing general agents and insurance companies. FileTrac Evolve comes with a diary system that includes reminders. It also integrates with Quickbooks and Outlook, Xactanalysis and Symbility. Other key features include time tracking, expense tracking, invoices, adjuster timesheets and image and video uploads. Accounting reports, quick notes and more are also included.

InsuraSphere is a complete suite of products and solutions that grow with your business. InsuraSphere is the complete product suite designed by insurance professionals for insurance professionals. All the essential information you need to manage your business, including quotes, claims, agents and policies, can be found in one place. InsuraSphere's integrated policy management system will streamline your processes. With agent and insured portals, you can give your stakeholders access the information and workflows that they require. Agents can rate, quote, or issue their own policies using your company's role-based permissions and business rules. Add third-party integrations to customize your company's workflows. InsuraSphere was designed to meet the changing needs of agents and carriers. InsuraSphere can grow with your business, whether you're just starting or moving from a legacy system.

I-CAPS, an Intelligent Claims Administration System, addresses all functional areas in the health claims payment environment. It uses a single architecture that covers the needs of payers, including billing, enrollment, claims, claims management, contracting and pricing. Our Intelligent Claims Administration System, I-CAPS, and our Coding Compliance Software (Advanced Value Scale -AVS), support knowledge-based decision making to help our clients reduce costs. With (Advanced Network Administrator -ANA), it is easier to ensure the integrity of Provider data. Our (RB-UCR), which is the first industry-first Resource-Based Usual Customary and Responsible fee schedule based upon RBRVS/NCCI, is also easier. Cost Containment Audit and Recovery Services, (CCARS), can be used to perform a non-invasive audit of claims effectiveness.

WLT's MediClaims program offers a cost-effective and straightforward approach to benefits and claims administration. WLT's integrated EDI processes and rules-based architecture allow for claims to be processed quickly and accurately. MediClaims offers a wide range of benefits and claim types, including Prescription Drugs, Vision, Medical, Dental, Vision, Prescription Drugs, Consumer-Driven Healthcare, Disability, Capitation processing, as well as processing capabilities. WLT's MediClaims system allows you to set up your groups for a single or multiple lines of coverage. Without reliable information systems, no plan can function efficiently. WLT is committed to using the most modern technologies available, providing you with the most flexible and sophisticated systems possible.

The ultimate insurance claims automation solution powered by patented Blockchain Technology. Claims are a critical moment for insurance. Our solutions have been designed to automate claims for insurers and insureds with unbeatable accuracy. MediConCen, a leading insurance software, automates claims and makes insurance available to insurance companies, medical networks and clinics. It uses Hyperledger Fabric blockchain technology. We equip claim assessors using powerful AI models, expert knowledge decision rule engine and expert knowledge to detect fraud and abuse instantly. Clean cases can then be approved immediately for consistently perfect cost management. With powerful analytics for claim management, you can be in the loop.

You can improve your claims management process and reduce denials with unmatched edits. Access to technology that allows for accurate claim submission and quick reimbursement is essential for health systems. Claims Director, SSI’s claims management software, streamlines billing processes and provides visibility by guiding users throughout the electronic claim submission process and reconciliation process. The system monitors changes in reimbursement criteria and incorporates them as they occur. The solution allows organizations to make the most of their reimbursement efforts by allowing them to edit at all levels: payer, industry, and provider.

Expedited claims. Multiple interfaces work in conjunction with your corporate brand. Access to digital data from any location, at any time. You can speed up your life and health processing by using faster systems that meet your needs. You can speed up your claims processing to meet the increasing number of claims. At the same time, you can reconcile and resolve more complex claims with record speed. It's here. It's out. There are no interruptions or delays in claims processing. CLAIMSplus expedites claims by working with employers, TPAs, and insurers using robust in-the cloud processing platforms. CLAIMSplusis focused on optimizing processes and expediting medical cases through secure, reliable, and efficient electronic claims management. Our technology, which is the core of our business, manages claims efficiently and quickly. We asked our clients and found that the claim's timeframe is the most important aspect of claims processing.

Easy Coder is a simple-to-use program that includes a quick procedure and diagnosis code search, encounter editing and compliance tools. It uses its web-based platform for real-time updates on content, rule changes and policies. No need to install software. Verifies medical necessity. Reduces the time required to code. All aspects of coding are combined. Allows for corrections to be made early in the revenue cycle workflow. Our medical billing service has used Alpha II's EasyCoder for almost 15 years. It has been a valuable tool that provides my staff with fast access to reliable, comprehensive, and current coding resources. Our staff has gained confidence and knowledge from the E&M Generate policy reviewer, support diagnoses lists and access to the Medicare fee schedules per locality. We strive to be a trusted resource for our clients.

Computer-Assisted Coding, also known as medical coding, helps to boost productivity, make critical decisions quicker, and reduce denials, missed fees, and low-risk score. The AGS Computer Assisted Coding module (CAC) allows for flexible and scalable coding to increase accuracy, productivity, efficiency, and flexibility. Features: Integrated Encoder : CAC has a built-in, 'book-based encoder' that helps you select the correct code. It also includes full guideline information as well as coding clinics. Integrated References - An integrated reference guide contains detailed visuals and information on anatomy for coders during the coding procedure. Integrated and 3M grouper: DRG/MSDRG grouping comes built-in. For those who require the 3M APR grouper, it can be activated easily through an existing integration with third party (3M fees apply).

PerioVision is a unique practice management solution for unique practices. It was designed for the surgical periodontist and includes all the tools and detailed reports you need to provide excellent care and increase profits. PerioVision continues to improve based on user input and technical innovations. It allows you to practice exactly how you want with customizable charts, comprehensive patient records, and a flexible platform. PerioVision is a tool that can help you reduce paper usage in your practice. Flexible architecture allows you to choose from a variety of technologies to make your office work for you. Its detailed reports allow you to track and improve referrals as well as production and collections. PerioVision allows your practice to go digital. Both medical and dental electronic health records are embedded in PerioVision. Cross-coding is possible by using both medical and dental codes, depending on the purpose of billing, insurance claims and record-keeping.

We work with private insurance clients to ensure that your therapy sessions are covered. Navigating your mental health bill and your insurance plan shouldn't be difficult. Nirvana streamlines the insurance process for you and your therapist. It covers everything from eligibility to reimbursement. This will allow you to save time, avoid headaches, and get paid quicker. Instead of spending hours calling insurance to find out what you are covered for, sign up now to get a clear understanding about your coverage. Nirvana simplifies the insurance process for both you and your client, from eligibility to reimbursement. You can track the submission, processing, adjudication, and lifecycle of your claims to easily monitor them. Filter by session and date ranges to gain a detailed understanding of the reimbursement amounts for your sessions.

Physicians did not attend medical school to learn to code. We are reimagining revenue cycle in the future with AI-powered automated coding. The platform is used by more than a dozen leading provider organizations and healthcare systems, which represent over 200 hospitals and 50K providers. CodaMetrix is a multi-specialty AI platform which translates clinical data into accurate sets medical codes to be used in patient care, revenue cycle processes and fee-for service models. The automation is transparent, touchless, and fully traceable. CodaMetrix’s cutting-edge multi-specialty, autonomous medical coding platform uses AI to continuously learn and act on the clinical evidence contained in the EHR. We translate clinical notes automatically into billing codes that meet coding requirements. This reduces the amount of work required by human coders.

MDofficeManager is a leader in revenue cycle management, medical coding and credentialing. We also offer practice management software, legal and business transcription services to medical, business, and legal entities. Our products and services simplify administrative and clinical processes through Cloud-Based and Server Based solutions. They facilitate information exchange and seamless communication between healthcare participants, thereby increasing efficiency and reducing costs. This allows for better decision-making and lower costs. MDofficeManager's Documentation management reduces costs and delivers timely, effective solutions to optimize your operations.

With one comprehensive software suite, you can improve clinical quality metrics, accuracy of risk scores, patient and provider involvement, patient outcomes, transparency in operations, and economic performance. Inovalon Payer Cloud transforms workflows into data driven processes that support the key objectives of your health plan. Our converged SaaS solution, backed by industry-leading analytics, delivers the member-centric insight, speed, accuracy and flexibility that you need to keep up in this ever-changing, diverse marketplace. Inovalon’s SaaS healthcare payer solutions deliver member-centric insights to help health plans improve healthcare outcomes, economics and quality. Payer solutions that improve member outcomes and care while improving operational performance and efficiency through sophisticated analytics and dynamic data intelligence.

With over 30 years’ experience, Hi-Tech Health has the expertise to service payers of all types and sizes, including TPAs, Carriers, Insurtech, Provider Sponsored Plans, and Medicare Advantage plans. Series 3000 is a cloud-based claims administration solution for businesses within the healthcare industry. No matter what your adjudication, reporting, or plan needs are, this platform reduces time processing claims and increases productivity as it assists with: •Client management •Benefits input •Electronic claim submissions •Claims processing With an implementation timeframe of 3-4 months, you can quickly get started with Series 3000. Our professional services and back office support teams are here to guide you through customization and training. With experts available at your fingertips, we’ll be able to support you so outside consultants won’t be needed. As your business grows, we’ll work with you to scale your software system to continue to meet your needs.

ClaimScore, the only independent software dedicated to solving the ever-growing claim fraud problem within Class Action Settlements. Each claim is evaluated individually in real-time using our AI, ML & Cloud Architecture. The results are reported instantly in an interactive dashboard. Each claim starts with a ClaimScore (1000) and is reduced by one each time it fails to meet a criterion. Each criterion is assigned a fixed or sliding weight based on the correlation between the criterion and fraudulent claims, as well as the correlation between the criterions and valid claims. To maximize transparency, every claim is tagged by deduction codes that are associated with the criteria they fail. This ensures that the parties, administrator and court know definitively why each claim has been rejected.

Quadient®, Correspondence allows you to manage your claims correspondence in the cloud. Quadient®, Correspondence is a subscription-based SaaS service that allows insurers to create and approve claims correspondence for customers. This can be done in both print and digital formats. There is no dependence on IT. Quadient Correspondence was created and priced for insurers that want to transform to digital but don't have the funds to invest in a full-service customer communications management (CCM). Business analysts update and create templates. Templates are approved by compliance experts and claims managers. Users of business correspondence can use a controlled editing process. Authorized personnel approve and review correspondence before it is sent. Instant delivery via email or SMS, PDF or email. Start by choosing the right claims correspondence template for your business and customizing it within the pre-defined editable fields.

Don't be afraid to try something new. This software was created to be simple to use and flexible. All data is stored on secure servers in cloud. You don't need to install anything. All you have to do is go to the website using any device and log into. You no longer have to worry about updates. We will update the website at regular intervals. Every employee in your company now has access to a customized database. Everyone in your company can now use the same item if you need to adjust the price of a common item in order to match local pricing. PowerClaim XML can be used as a standalone property adjusting software package. It allows you to quickly create estimates, as well as photo sheets, diagrams and captioned reports. PowerITV Replacement Cost Calculator allows you to quickly and accurately calculate the replacement cost for virtually any structure using the Craftsman Book Company's timely data.

All-in-one solution for your medical practice. Cloud-based online electronic health records (EHRs) that allow you to create and manage patient records securely from your browser. You can create and manage patient appointments, schedule resources such as rooms, IV chairs, etc. Use a color-coded calendar. Patients can book appointments through your website and patient portal. Upload and store patient and practice documents such as consent forms, handouts, x-rays, etc. Go paperless. To make it easy to find documents, group them into folders and tag them. Securely exchange messages with your care team regarding your treatment. Patients will be able to access their medical records via portability. They can also allow secure access to a local specialist when they visit abroad. You can discuss complicated cases while sharing images/videos, without having to pull doctors from clinics or wards.

Jopari ProPay, a cloud-based solution for healthcare payers, is a payment processing system. It offers a complete suite of payment methods including EFT/ERA payments, virtual card payments and paper checks. Jopari ProPay helps healthcare payors eliminate paper and reduce operating expenses by streamlining payment and remittance processes. It allows payers to outsource payment processing so they can focus on other core tasks. Jopari ProPay gives providers a choice of multiple payment delivery methods, so that they can select the one that best suits their needs. The self-service portal allows providers to view their EOBs/Rs, and track their payments. Over 50,000 ERISA plans and fully insured groups trust Jopari ProPay as a secure, compliant and compliant payment processor.

We believe you can build modern applications that deliver digital experiences and drive business growth without having to write any custom code. That's why it's our mission to empower enterprises in complex and regulated industries to re-imagine application development by enabling them to be connected, innovative, quick, and nimble. Backed by leading investors including Everstone Capital and Paulson & Co, Innoveo’s cloud based, AI enabled no-code platform is currently in production globally at over 30 industry leaders across insurance, financial services, healthcare and real estate. With Innoveo, you’ll get the solutions and industry expertise you want, plus a little extra: a thoughtful, no-nonsense experience delivered with a refreshing dose of honesty.

F1RSTAnesthesia, an Oracle-based proprietary software platform, is what best describes our unique approach to managing accounts receivables. F1RSTAnesthesia, which is the result of over 40 years of anesthesia billing services, practice management and software development, allows ABC staff to interact with patients, providers and their insurance plans in real-time. This allows clients to receive the best and most accurate payment for the services they provide. Unlimited ability to improve the retrieval and accuracy of documentation received. The features and functionality of the software are designed to simplify the complex triage and billing of medical services, including the monitoring and enforcement of payer guidelines and payment accuracy.

ClpHub, a global provider for cloud-based insurance software designed for insurance companies in all sizes, is a global leader. Their platform provides a flexible configuration tool which allows the creation of any type of product without a development process. This allows businesses to create new products and services with configuration tools. No coding is required, no development team and no technical knowledge is needed. ClpHub automates business processes for policy and claim administration, reducing costs and manual work. The platform allows remote onboarding. This allows customers to be onboarded without having to visit a branch. It also offers a user-friendly, intuitive interface that employees will enjoy, powerful APIs to integrate third-party services and customer portals into the insurance core, as well as a platform that is accessible from any device with an internet connection, including PCs, laptops, tablets, smartphones, or mobile phones.