Alternatives to CoverSelf

Speed up payment processes while minimizing administrative tasks. With over 8,000 payer connections and established collaborations with more than 650 practice management vendors, our claims management solutions lead to a reduction in pending claims and decreased need for manual efforts. Efficiently and accurately send claims for various services, including professional, institutional, dental, and workers' compensation, ensuring prompt reimbursement. Tackle the evolving landscape of healthcare consumerism by delivering a smooth and transparent financial experience. Our patient engagement tools enable you to facilitate informed discussions around eligibility and financial obligations, while also lowering obstacles that could affect patient outcomes, ultimately fostering better healthcare experiences.

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.

Revenue cycle management plays a crucial role in the success of medical service operations, serving as a fundamental pillar for their sustainability. Essential tasks such as controlling expenses, boosting efficiency, and speeding up reimbursements are vital for the smooth operation of emergency medical services. However, navigating a claim through its entire lifecycle has often been a laborious process, frequently delayed by issues related to documentation and coding errors. ZOLL® Billing offers a cloud-based solution that significantly enhances billing effectiveness, allowing revenue cycle professionals to maximize financial returns. By streamlining workflows and reducing billing mistakes, ZOLL Billing empowers users to handle a greater volume of claims while minimizing resource expenditure, all while addressing compliance risks. With automated workflows, you can improve productivity and revenue, enabling your team to process an increased number of claims seamlessly. This innovative approach not only simplifies the billing process but also positions your agency for greater financial success in the competitive healthcare landscape.

Boost your organization's cash flow by efficiently handling claims from Medicare, Medicaid, and various commercial payers. With our automated system, you can process all payer claims in real-time from any location, ensuring faster payment for your claims. You have the ability to submit and monitor your claims at any moment, benefiting from real-time updates on their status. A dedicated account manager, who is a certified healthcare claims expert, will be assigned to you, and you will even have their mobile contact number for immediate assistance. Expand your revenue streams and enhance your cash flow through our automated claims processing, which provides complete visibility into all your electronic funds transfers (EFT) and payment forecasts. You can streamline the processing, tracking, and resolution of claims in real-time to maximize revenue and eliminate time-consuming tasks. Additionally, our system automates Medicare eligibility verification alongside claims processing to further enhance efficiency. By adopting this approach, you can significantly reduce administrative burdens and focus on what matters most—providing excellent care to your patients.

Gain a comprehensive understanding of your clients through an intuitive interface that presents encounters, core service interactions, segments, claims, and billing statuses. Care Managers can effectively monitor advancements in addressing care gaps for members. These documents can be seamlessly linked to care plans, enhancing both tracking and reporting efficiency. Claims and documentation can be sent directly to the MAPP HHTS, supported by a top-tier MAPP synchronization process and continuous customer assistance. The system allows for the efficient generation of claims and CMA statements while automatically managing Health Home billing prerequisites. In cases where HML rate codes are modified, you can easily void and resubmit claims. Built-in HML logic ensures that HMLs are completed with the required number of core services, face-to-face encounters, and other pertinent criteria. Participate in roundtable discussions with fellow users to explore our product roadmap and the evolving requirements of Health Home. Our team is committed to regularly checking in with clients to cater to their specific needs and enhance their experience. This approach not only fosters better communication but also ensures that we are aligned with our customers' goals and expectations.

Anomaly is an innovative AI-driven platform designed for payer management that empowers healthcare revenue teams to understand their payers as thoroughly as those payers understand them. By revealing hidden behaviors of payers through the analysis of intricate rules and payment trends across millions of healthcare interactions, it enhances operational efficiency. Central to this platform is its Smart Response engine, which perpetually scrutinizes payer logic, adjusts to evolving policies, and integrates its insights into current revenue cycle processes, enabling real-time predictions of denials, support in claims adjustments, and alerts regarding potential revenue threats. Users gain the ability to foresee revenue shortfalls, negotiate more effectively with payers, and proactively address or overturn denials, thereby safeguarding cash flow. This advanced system effectively bridges the gap between providers and payers, transforming complex billing frameworks into practical intelligence that informs daily financial management while also fostering an environment of enhanced strategic decision-making for revenue teams. By empowering users with this level of insight, Anomaly not only improves operational outcomes but also contributes to a more equitable balance in the healthcare financial landscape.

The influence of digital technologies on the insurance sector is profound, with those adapting to these changes set to gain a strong competitive edge. Outdated claim management systems that rely on numerous platforms, physical documents, and labor-intensive procedures are now being supplanted by cloud-based enterprise claim management solutions. The Majesco ClaimVantage Claims Management Software for Life and Health simplifies the entire claims process, encompassing every stage from initial intake to payment calculations, while seamlessly integrating various systems to enhance information flow throughout the organization. By ensuring precise and prompt claim decisions, businesses can elevate customer satisfaction and boost operational efficiency. Additionally, built on the Salesforce Lightning Platform, Majesco ClaimVantage Claims Management Software for L&H empowers insurance firms and third-party administrators to not only modernize their claims handling but also to position themselves for future advancements in the industry. As the landscape evolves, embracing such innovative solutions will be crucial for sustained success.

PLEXIS offers a comprehensive suite of top-tier applications designed to equip payers with the advanced capabilities required for contemporary core administrative systems. These applications encompass functionalities such as real-time benefit management, adjudication, automated EDI transmission, and self-service customer portals, ensuring that PLEXIS Business Apps meet all your needs. The Passport feature facilitates crucial connections between core administration and claims management systems, PLEXIS business applications, custom applications, and existing internal systems. Its adaptable API layer allows for real-time integration with various portals, automated workflow tools, and business applications, ensuring that connectivity knows no bounds. By employing this centralized, modern core administration and claims management platform, you can enhance workflows effectively. This approach enables the efficient processing of claims while simplifying the complexities associated with benefit administration, resulting in a swift return on investment and the ability to provide exceptional customer service. Ultimately, PLEXIS empowers organizations to thrive in an increasingly complex healthcare landscape.

Insurance Discovery enhances financial outcomes by uncovering previously unrecognized billable coverage that providers may not be aware of, thereby minimizing underpayments and uncompensated care. By employing advanced search functionalities, this solution reveals instances where patients possess multiple active payers, which can significantly improve reimbursement prospects. Additionally, it helps to prevent delays in reimbursement and accelerates revenue collection by ensuring that claims are submitted to the correct payers on the first attempt, thanks to more precise coverage details. When utilized with verified demographic information, Insurance Discovery provides reliable coverage and eligibility insights. This modern approach replaces outdated manual methods of insurance discovery with a swift and thorough search that queries numerous databases in mere seconds, yielding detailed and accurate coverage information. Furthermore, it enhances the overall experience for patients and residents by facilitating accurate estimates of out-of-pocket expenses, ultimately contributing to a more favorable financial journey for them. By streamlining these processes, providers can focus more on patient care rather than administrative tasks.

IMPOWER is a specialized document management system designed specifically for the healthcare sector, featuring a modular architecture that allows it to expand from managing documents associated with EMR to becoming a comprehensive enterprise solution. Its intuitive user interface mimics a traditional paper filing system, facilitating a quicker transition to full operational efficiency. More than just a simple scanning tool, IMPOWER offers the capability to maintain precise digital replicas of all patient statements ever issued, organized by patient and readily accessible for viewing, printing, or faxing without the need for scanning. Imagine having a complete archive of every claim submitted, whether electronically or on paper, seamlessly integrated with a standard claim form without any extra effort. The same applies to every electronic remittance received from all payers, effortlessly tracked and managed. What distinguishes IMPOWER from its competitors is its EDI-to-paper-equivalent conversion of healthcare-related documents, but the innovation does not end there, as it continues to evolve and adapt to meet the changing needs of the healthcare industry. This adaptability ensures that healthcare providers can streamline their operations while maintaining high standards of patient care and documentation management.

eClaimStatus offers a straightforward, practical, and efficient real-time system for Medical Insurance Eligibility Verification and Claim Status solutions that enhance healthcare delivery environments. As healthcare insurance providers continue to lower reimbursement rates, it becomes essential for medical professionals to keep a close eye on their revenue streams and minimize any potential loss and payment risks. The issue of inaccurate insurance eligibility verification is responsible for over 75% of claim denials and rejections from payers. Additionally, the costs associated with re-filing rejected claims can reach between $50,000 to $250,000 in lost annual net revenue for each 1% of claims that are denied (according to HFMA.org). To address these financial challenges, it is crucial to have a user-friendly, budget-friendly, and efficient Health Insurance Verification and Claim Status software. eClaimStatus was specifically developed to tackle these pressing issues and improve overall financial performance for healthcare providers. With its comprehensive features, eClaimStatus aims to streamline the verification process, ultimately enhancing the efficiency and profitability of healthcare practices.

Introducing the first-ever intelligent medical billing software that caters to multiple specialties. It simplifies the billing process and enhances patient collections for over 75,000 healthcare providers nationwide. With its global data capabilities, there's no longer a need for entering information multiple times. Designed to handle large volumes and intricate data, it features a flexible data structure that meets the diverse needs of various practices and specialties. This software ensures that you receive payments more quickly. You can input payments manually or utilize electronic remittance options. Claims are automatically scanned for errors and any missing details, ensuring accuracy. Additionally, the software can automatically resubmit insurance claims based on predetermined criteria. The rapid review feature allows for swift evaluation and approval of charges. You can audit charges by various metrics, including modality, procedure, insurance, user, or date of service. The intuitive reporting system provides insights into the financial well-being of both front-end and back-end billing processes. You’ll never miss a charge again. Furthermore, it seamlessly integrates with your chosen clearinghouse or statement vendor, making it a versatile choice for healthcare billing. With its user-friendly interface and comprehensive features, this software is set to transform the way medical billing is handled in practices.

GEMMS ONE integrates seamlessly with EHRs, allowing for seamless workflows throughout the patient care process. GEMMS ONE integrates with clients to allow them to track patient appointments and create charges. They can also process claims, post electronic payment, run PM reports, manage collections, and process claims. GEMMS Patient Portal provides patients 24/7 access to their personal health information. It also enhances patient-provider communication, leading to better outcomes. GEMMS ONE can be integrated with other systems in a flexible and efficient manner. Specific interoperability requirements can be met with the ability to export and import data or text. Multiple ways.

I-CAPS stands for Intelligent Claims Administration System, designed to comprehensively cover all aspects of the health claims payment sector through a unified architecture that meets the diverse requirements of payers, including areas such as membership management, billing, enrollment, mailroom operations, claims processing, network oversight, contracting, pricing strategies, utilization reviews, and customer support. Our I-CAPS, along with our Advanced Value Scale (AVS) coding compliance software, facilitates informed decision-making to assist clients in managing expenses effectively. The Advanced Network Administrator (ANA) ensures the accuracy of provider information in an efficient manner, while our Resource-Based, Usual Customary, and RESPONSIBLE fee schedule (RB-UCR) is a pioneering solution in the market, built on RBRVS and NCCI frameworks. For a thorough assessment of your plan or provider’s performance, consider utilizing our Cost Containment Audit and Recovery Services (CCARS), which provide a meticulous and non-intrusive evaluation of claims efficiency. This holistic approach not only enhances operational effectiveness but also promotes greater transparency within the health claims ecosystem.

Paradigm Senior Services provides a comprehensive, AI-driven revenue cycle management solution designed specifically for home-care agencies that handle billing for various third-party payers, including the U.S. Department of Veterans Affairs (VA), Medicaid, and several managed-care organizations. The platform automates and enhances each phase of the billing and claims workflow, encompassing tasks such as verifying eligibility and authorizations, managing state- or payer-specific enrollment and credentialing, submitting accurate claims, addressing denials, and reconciling payments. It seamlessly integrates with widely used agency management software and electronic visit verification systems, enabling the scrubbing of shifts, weekly authorization verifications, and efficient payment reconciliations, all of which contribute to a reduction in denials and a lighter administrative load. Additionally, Paradigm offers "back-office as a service" for healthcare providers; this means that even if agencies have their own billing personnel or scheduling applications, Paradigm is equipped to manage claims processing, functioning as a dedicated, expert billing department. This flexibility allows agencies to focus more on patient care while leaving the complexities of billing in the hands of specialists.

iRely i21 is a sophisticated software solution designed for commodity trading and risk management (CTRM), assisting organizations in managing various operations such as logistics, procurement, finance, and claims processing from a unified platform. This software empowers employees to receive automated risk alerts, access market exposure reports, monitor risk positions, produce margin analyses, and perform stress testing efficiently. Furthermore, iRely i21 facilitates the reservation of inventory contingent on customer sample approvals and purchasing choices while overseeing contractual conditions tied to pricing fluctuations. It allows team members to customize analysis periods for both realized and unrealized profitability, thereby minimizing inaccuracies in month-end profitability evaluations. Additionally, the real-time accounting feature enables users to create invoices based on varied criteria like delivery schedules, contractual obligations, and fixation parameters. Moreover, it provides supervisors with the ability to create documents and automatically update the status of parcels along with pertinent shipping instructions, release orders, and shipping advice, ensuring seamless operations throughout the entire process. This integrated approach not only streamlines workflows but also enhances overall decision-making and operational efficiency.

Medinous is a web-enabled, fully integrated Hospital Management System that can be used by large and mid-sized hospitals and clinics. It was designed for simplified operations, superior patient care, and increased administration & control. Our goal is to integrate and automate your entire hospital's process flow, including clinical areas, support functions, finance, supply chain, administrative, and billing functions. We facilitate quick integrations to PACS, Lab/Medical Equipment, Drug Databases, and Payer Connections for ease of use.

Introducing a cutting-edge and efficient method for managing and settling insurance claims. This comprehensive, all-in-one solution caters to various types of insurance, including property, liability, and workers’ compensation. ClaimRuler™ is a state-of-the-art cloud-based claims management platform crafted specifically for Independent Adjusters, Third-Party Administrators, CAT Adjusters, Insurance Carriers, Self-Insured entities, and Municipalities. The system facilitates seamless claims processing with integrated guided workflows, extensive reporting features, and an automated diary system that enhances the efficiency of the claims settlement process. Designed with the real-world needs of industry professionals in mind, ClaimRuler™ offers a user-friendly and functional interface, making it easier to manage forms, lists, documents, and images. Whether you are part of an I/A firm, a TPA, an insurance carrier, or a municipality, ClaimRuler™ is flexible and scalable to grow alongside your organization. This adaptability ensures that users can navigate the platform with ease while meeting the evolving demands of the insurance landscape.

The process of patient access serves as the foundation for the entire revenue cycle management in healthcare. By ensuring that patient information is accurate from the outset, healthcare providers can minimize errors that often lead to additional work in administrative departments. A significant portion, between 10 to 20 percent, of a healthcare system's revenue is spent on addressing denied claims, with a staggering 30 to 50 percent of these denials originating from the initial patient access phase. Transitioning to an automated, data-oriented workflow not only mitigates the risk of claim denials but also enhances patient care access, thanks to features such as round-the-clock online scheduling options. Furthermore, patient access can be refined by streamlining billing processes through real-time eligibility checks, which provide patients with precise cost estimates during registration. Additionally, enhancing registration accuracy leads to greater staff efficiency, allowing for immediate rectification of discrepancies and errors, thereby preventing expensive claim denials and the need for further administrative corrections. Ultimately, focusing on these elements not only safeguards revenue but also elevates the overall patient experience.

Over half of all companies lack strong assurance in their data quality. Boost your trust in address data instantly with our cutting-edge real-time address validation solution. Our advanced address validation software meticulously cleans, corrects, and standardizes address information prior to any mailing. This innovative software is engineered to handle the significant discrepancies often found in addresses by correcting spelling errors and inaccuracies, providing missing data elements, and ensuring records are uniform. Additionally, our address validation service holds certifications from both the U.S. Postal Service® CASS Certified™ and Canada Post SERP, guaranteeing its reliability and effectiveness. By utilizing our service, you can enhance your data integrity and ensure successful communication.

Our state-of the-art system provides instant patient financial and clinical results to private small and medium healthcare providers. This allows for a seamless, seamless integration of technology into daily operations. Docta makes it easy to work with computers, regardless of how big or small your practice is. It has a simplified interface that allows you to browse your patients and find records much faster. It's easy to keep track of your patients, consults, vital signs and prescriptions. Get paid faster! You will get paid faster, regardless of whether you submit claims electronically. Use the right office tools to communicate with patients and potential patients.

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

HealthRules® Payer represents a cutting-edge core administrative processing system that offers transformative features for health plans across various types and sizes. For over a decade, health plans utilizing HealthRules Payer have effectively capitalized on market opportunities, maintaining a competitive edge. What sets HealthRules Payer apart from other core administrative solutions is its innovative application of the patented HealthRules Language™, which resembles English and introduces a groundbreaking methodology for configuration, claims management, and information transparency. This system empowers health plans by enabling them to expand, innovate, and outperform their peers more effectively than any other core system available today. As a result, HealthRules Payer not only streamlines operations but also fosters a culture of agility and responsiveness within health organizations.

Our advanced recognition system, SeeWare®, features a flexible and expandable architecture that allows for the interpretation and comprehension of the physical world. This capability facilitates a profound understanding of activities in various locations, revealing insights that enhance and streamline operations for a cohesive retail environment. Leveraging current infrastructure, SeeChange’s groundbreaking solutions address the most pressing issues faced by retailers today. By minimizing friction at self-checkout points, customers enjoy a smoother shopping experience, while businesses benefit from decreased inventory errors and increased profitability. Furthermore, our innovative spill detection technology empowers retailers to proactively manage potential hazards. Utilizing existing CCTV systems, our award-winning solution swiftly identifies liquid spills and debris, providing real-time notifications to mitigate risks and avert accidents, ultimately enhancing safety and operational efficiency. As a result, retailers can maintain a cleaner environment while fostering customer satisfaction and loyalty.

Five Sigma embarked on a quest to empower claims organizations to embrace innovation. Their collection of claims management tools and distinctive platform equips insurers with what is necessary to adapt their claims operations to an ever-evolving environment. By offering a suite of Claims-First Cloud-Native and User-Centric products, Five Sigma enhances the capabilities of adjusters, enabling them to manage claims more effectively and swiftly. Through the automation of routine administrative tasks, adjusters can concentrate on making informed decisions while the system efficiently manages the rest. Introducing Clive™ by Five Sigma, the first AI-driven claims adjuster in the industry, is revolutionizing the claims processing landscape for insurers, MGAs, and TPAs. By harnessing cutting-edge AI and automation, Clive optimizes the entire claims lifecycle, from the First Notice of Loss (FNOL) to the final settlement. This AI agent not only boosts the efficiency of claims handling but also improves accuracy and reduces costs by automating various tasks, ultimately leading to a more streamlined and effective process for all stakeholders involved. In this way, Five Sigma is setting a new standard for the future of claims management.

CaseworksPro is a cost-effective online claims management system tailored to meet diverse claims processing needs. Created by Insurance Technology Solutions, this platform is specifically designed for the claims departments of insurance carriers, self-insured retentions (SIRs), and third-party administrators (TPAs). With its user-friendly interface, CaseworksPro incorporates a variety of functionalities, such as workflows centered around SIR clients, the ability to capture policy data, options for both one-off and scheduled payments, customizable user access permissions, check printing capabilities, electronic reporting features, and the ability to capture NCCI and ISO statistical codes. Additionally, its comprehensive approach ensures that all stakeholders can efficiently manage claims while maintaining compliance with regulatory standards. This makes CaseworksPro an invaluable tool in the claims administration landscape.

Sensei CRM empowers you to take charge of your pricing strategy. Featuring an advanced pricing engine, it enables you to calculate prices for intricate metal buildings within minutes. With multiple manufacturing partners and regular updates to their pricing, you can rest easy knowing that you won't have to deal with unexpected price fluctuations. A truly personalized customer experience is essential, as effective inbound marketing focuses on placing customers at the forefront. Additionally, the comprehensive workflow management system permits managers to check orders and quotes for any potential pricing errors. This means that sales professionals can avoid time-consuming manual processes by simply selecting a manufacturer; Sensei's efficient software fills out the necessary PDF forms and sends them directly via email. Moreover, this integrated system not only optimizes efficiency but also enhances communication between teams, ensuring a smooth operational flow.

Claims Signal™ represents a revolutionary open claims quality solution developed by Aon and Athenium Analytics, designed to help insurers detect high-risk claims at an earlier stage. By improving the experience for policyholders, this platform can lead to a significant enhancement in claims indemnity and expenses, estimated between 4% to 6%. In today's fast-paced insurance environment, claims teams face mounting pressure to elevate customer satisfaction, streamline operations, and minimize financial leakage. While routine quality audits can effectively highlight root causes and deviations from optimal practices, the feedback from these audits may not be accessible for weeks or even months post-claim closure. Imagine having the ability to continuously monitor open claims and resolve quality concerns before they negatively impact results. The Claims Signal platform leverages advanced artificial intelligence to scrutinize open claims, identify potential problems, and send immediate alerts, empowering front-line managers to take action before a claim reaches conclusion. With the integration of predictive analytics and timely alerts, insurers can achieve a reduction in claims leakage of up to 4%, ultimately transforming the claims management process. This proactive approach not only enhances operational efficiency but also fosters a culture of continuous improvement within claims teams.

Venue ™ Claims Management for Independent Adjusters offers a complete solution for overseeing the entire claims processing workflow. This system is suitable for various entities, including adjustment firms, third-party administrators, insurance carriers, and self-insured organizations. Users can enjoy a highly customizable interface, enabling significant self-modification of the claims management system to meet their specific needs. The platform includes a built-in web service interface, facilitating real-time or batch data imports, updates, and exports to nearly any external data-sharing source concerning all claim-related information. Furthermore, seamless integration with policy and billing systems ensures real-time synchronization of all policy-related details, which may encompass essential policy dates and alerts, such as ongoing fraud investigations and assumed policies. The system provides thorough capabilities for every dimension of claims processing—spanning claim payments, recovery processes, reserves tracking, contact management, trust accounts, forms templates, and extensive reporting functionalities. Overall, Venue ™ empowers organizations to enhance their claims management efficiency and effectiveness.

Transform and analyze your data through dimensions specified by users to extract valuable insights regarding both real cash flows and projected cash forecasts. Create a personalized dashboard to visualize and centralize crucial information effectively. Keep track of your balances and cash flows in various currencies by utilizing your foreign exchange rate sets. Aggregate local contributions to assess your cash flows on a global scale, while also having the capability to delve deeper into specific areas of interest, down to individual transaction details. Manage millions of transactions to generate a comprehensive forecast, meticulously examining each transaction to identify discrepancies in your cash flow predictions. Gain insights into areas for enhancement by juxtaposing actual figures against forecasts within a detailed variance analysis framework. Integrate this variance analysis seamlessly into your forecasting routine to uncover inaccuracies and implement improvements that enhance the overall forecasting accuracy for future periods. This holistic approach not only aids in financial management but also empowers strategic decision-making across your organization.

Streamline the management of progress claims by reducing administration time by as much as 50%. Effortlessly access and assess standardized claims generated through Payapps by your supply chain partners. The system features customizable approval workflows and automated notifications that prompt timely responses and the issuance of payment schedules, ensuring adherence to security of payment regulations while upholding your reputation for prompt payments. Payapps can function as an independent solution or seamlessly integrate with prominent construction ERP and accounting systems, thereby standardizing your processes and documentation. You will gain comprehensive visibility into the status of claims during the approval stages. By connecting with your construction finance software, Payapps automates the transfer of vital financial information, enhancing efficiency, eliminating the need for repetitive data entry, and minimizing error risks. Furthermore, Payapps automatically carries forward and reconciles previously approved claims, so you can avoid spending unnecessary time on spreadsheets or redoing last month's claims, ultimately allowing you to focus on higher-value tasks. With this streamlined approach, your operations become not only more efficient but also more reliable.

EIS offers a cutting-edge, cloud-native, API-first SaaS platform tailored for the insurance industry, empowering dynamic insurers to innovate with the agility of a technology firm. Their comprehensive platform accommodates various lines of business, such as group benefits, property and casualty, life and annuities, and protection. With an architecture that is open, event-driven, and responsive in real time, EIS enables insurers to enhance their agility and operational efficiency, facilitating swift innovation, quicker product launches, and the creation of new revenue streams while fostering customer-focused insurance solutions. The platform comprises essential core systems, including PolicyCore for managing policies, BillingCore for overseeing billing processes, ClaimCore for claims management, and CustomerCore for managing customer relationships. These components can function independently or as an integrated suite, ensuring seamless end-to-end support across the entire insurance lifecycle, which encompasses policy management, underwriting, claims processing, billing, and customer engagement. By leveraging this robust platform, insurers can effectively respond to market demands and enhance their overall service delivery.

Imagine a future where precision and correctness are achieved through advanced AI technology, enabling businesses to bring their products to market with greater speed and simplicity, while also enhancing customer acquisition through personalized lending solutions and superior experiences; this is the reality that Lentra embodies. Lentra is a revolutionary platform designed specifically for the financial sector, meticulously crafted to meet every expectation of modern financial institutions. It offers a ready-to-use solution that can be deployed swiftly, featuring tailored customer journeys supported by a microservices architecture. With a pay-per-user or transaction SaaS model, there is no upfront capital expenditure required, ensuring accessibility for all types of organizations. The platform operates continuously, backed by dedicated data centers and reinforced by a robust, secure infrastructure. Its API-driven approach allows for seamless integration with third-party services, while horizontal scaling capabilities enable it to adapt to growing demands. Covering a wide range of lending needs from personal loans to credit cards, Lentra also empowers merchants to become effective cross-sell agents, proving itself as a comprehensive solution for any financial institution. This innovative platform not only enhances operational efficiency but also transforms the way lending is approached in the industry.

Thrizer is an innovative payment solution aimed at streamlining the billing process for out-of-network therapy services, catering to both therapists and their clients. For therapists, it operates similarly to well-known payment processors such as Stripe or Square, allowing them to charge clients while efficiently handling out-of-network claims submissions, which significantly lessens the administrative load and eliminates the necessity for superbills. Clients are able to pay only their co-insurance after meeting their deductibles, as Thrizer takes care of the remaining fees upfront and manages the insurance reimbursement process on their behalf, thus lowering initial costs and facilitating quicker access to therapeutic services. Furthermore, Thrizer features a complimentary real-time benefits calculator that enhances transparency by providing insights into out-of-network benefits and anticipated out-of-pocket expenses prior to therapy sessions. In addition, it includes a superbill upload option for clients whose therapists opt not to use the platform, allowing them to navigate their claims with greater efficiency. This comprehensive approach not only simplifies the billing experience but also fosters a more accessible path to mental health care for all users.

Measmerize provides a seamless size recommendation system tailored for fashion retailers. Customers can easily access the size advisor from any product page and receive precise size recommendations for apparel, footwear, and kids’ products. Sizing challenges often lead to expensive returns and dissatisfied shoppers. To combat this, Measmerize harnesses cutting-edge AI technology to offer an accurate and dependable solution for sizing issues in fashion retail. By evaluating diverse data points, such as product specifications and body measurements, Measmerize ensures shoppers are given personalized size suggestions, leading to a smoother and more enjoyable shopping journey. Easily integrated, Measmerize empowers customers to make confident choices, lowering return rates while enhancing satisfaction. This innovative solution not only simplifies the shopping experience but also boosts critical performance metrics for retailers, including Conversion Rate and Average Order Value.

Streamline the budgeting process across the entire organization by utilizing a user-friendly, web-based platform integrated with Excel that automates oversight and manages the budget workflow. This approach allows for a clear comparison of actual versus planned figures, enabling more informed decision-making through an Excel-centric reporting system that minimizes repetitive tasks and mitigates the risk of errors associated with manual data handling. Ultimately, this modernization not only enhances efficiency but also promotes accuracy in financial planning and analysis.

Utilizing our claims listing page enables you to swiftly address any errors or omissions before you submit your claims. Once all necessary information has been recorded and the relevant diagnosis and modifier codes have been applied, you can effortlessly upload a batch of claims to Trizetto Provider Solutions® in a single action. Following this, Trizetto Provider Solutions® conducts an additional round of claim scrubbing before forwarding your submissions to the appropriate payers. After payments from insurance companies are processed, you will see updates against claims that reflect allowed amounts, adjustments, copays, coinsurance, and deductibles. To maintain precision, payments are entered in groups. Statements are prepared according to your specified frequency—be it daily, weekly, or monthly—and are designed in a straightforward format that patients can easily comprehend. This clarity eliminates any prior confusion! Furthermore, a section for credit card authorization is included on the statement to facilitate the convenient settlement of any outstanding balances, ensuring a smooth payment process for patients.

Nexus EHR is a cloud-based, ONC-certified EHR and PM system for clinical healthcare providers. Nexus EHR works with your clinical workflow and maximizes the physician-patient encounter. Access anywhere, any time, and with any device (PC, Tablet, Mobile). Breeze through encounters via our intuitive, easy-to-use interface that allows you to practice naturally. Nexus PM helps you practice maximizing your revenue by simplifying billing operations. Physicians can use Nexus telemedicine for e-visits. Nexus patient portal gives patients a better control to fill demographics, insurance details, and histories before the appointment.

RiskEnvision is an all-encompassing suite of modular RMIS products designed for enterprise-level risk management and claims administration that operates entirely on the web. This platform is equipped to handle various functions such as payment processing, reserve management, correspondence, policy oversight, diary management, and reporting across multiple insurance lines, including Auto, General Liability, Products, Property, and Workers' Compensation, all within an intuitive interface that requires minimal upkeep. With the capability for immediate implementation, RiskEnvision enables users to swiftly leverage the advantages of a fully web-based solution for their risk management and claims processes. Additionally, ACES has been specifically created to address the increasing demand for innovative tools focused on cost containment and effective claims management within the workers' compensation and property and casualty sectors, further enhancing the overall functionality of the RiskEnvision suite.

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

BHRev is an innovative platform designed specifically for revenue cycle management and automation, tailored to meet the needs of behavioral health providers, enabling them to enhance their financial operations from the initial claims submission all the way through to payment collection through the use of AI-driven automation and specialized expertise. By addressing the distinctive challenges encountered by behavioral health organizations—such as complicated payer regulations, stringent documentation demands, elevated denial rates, and changing compliance requirements—BHRev automates as much as 80% of revenue cycle management tasks, while allowing skilled professionals to manage exceptions, ensure compliance, and oversee intricate billing processes, resulting in quicker reimbursements and reduced administrative mistakes. This platform effectively merges cutting-edge automation with expert human oversight to tackle essential processes like verifying insurance eligibility, processing and scrubbing claims, managing denials, and posting patient payments, thereby alleviating the operational strain on clinics and boosting their cash flow. As a result, BHRev not only streamlines financial workflows but also empowers behavioral health practices to focus more on patient care.

BRMS excels in the efficient and precise processing of all Medical, Dental, Vision, and Retiree claims, ensuring a swift turnaround time. We seamlessly update eligibility each night through our MyHealthBenefits system, maintaining up-to-date information. Our expertise in PPO negotiations allows us to effectively lower costs for employers regarding claims. We oversee the full spectrum of claims administration, from initial receipt and eligibility verification to negotiation and final payment. By centralizing all operations in-house, including claims processing, medical management, PPO network oversight, and billing, we offer a responsive and personalized service experience. For self-insured entities, BRMS serves as an invaluable partner in handling Medical, Dental, and Vision claims with exceptional accuracy and efficiency. Our commitment to quality and customer satisfaction sets us apart in the industry.

SmartFusion serves as an all-encompassing financial management software system for schools, consolidating essential data into a single, accessible platform. Enhance your productivity by simultaneously accessing multiple reports and windows, streamlining your workflow. Effortlessly broaden your functionality with seamless third-party software integrations. Rest assured that your confidential financial data remains protected at all times. Gain greater control over your operations by eliminating the need for data re-entry through fully integrated modules. Benefit from the flexibility to work from any location, utilizing cloud capabilities or the option to self-host. With built-in state and federal reporting features, you can put your compliance concerns to rest and ensure data accuracy with ease. This empowers you to focus on what truly matters—enhancing the educational experience.

In today's world, a hospital or clinic cannot operate efficiently without a digital system in place. Centralize patient records, scheduling, billing, and financial documents to ensure quick access and seamless collaboration among staff. By minimizing expenses related to hiring extra personnel and reducing the need for physical office space, you can save significantly on your monthly budget. The improvement in patient workflows and productivity will allow your facility to serve a greater number of patients each day. By keeping your database on-site, you ensure that no external parties can access sensitive information, including financial data and patient records. Transitioning to an automated system for generating medical invoices and claims will help to minimize errors in billing and dispensing. This strategic move not only protects privacy but also enhances the overall efficiency of healthcare delivery in your organization.

Shift’s Payment Integrity offers an advanced AI-driven solution tailored for health plans, aimed at enhancing the precision and minimizing expenses involved in the claims payment process. This innovative tool operates effectively during both pre-payment and post-payment phases, enabling plan administrators to identify potential issues early on while also recovering overpayments efficiently. Among its notable features are dynamic claims editing with updated rules, AI-supported reviews of medical records, detection of anomalies as well as instances of fraud, waste, and abuse, and integration of external data for a more comprehensive analysis. The system is designed to adapt to changing policies and guidelines, featuring automated policy assessments and an edit logic workbench that allows health plans to experiment with concepts prior to implementation. It also includes clear flags and alerts that inform reviewers about the reasons behind claim flagging, facilitates faster document reviews by emphasizing key sections of records, and employs data mining techniques to uncover emerging trends. Additionally, the platform boasts a cohesive case management interface that streamlines investigative workflows, further enhancing operational efficiency for health plans.