Enterprise Health Solution Description
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.
Enterprise Health Solution 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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Meet Healthee—your intelligent healthcare navigation platform.
Healthee takes the guesswork out of healthcare by delivering clear, personalized answers to employees’ healthcare and benefits questions—instantly. Employees can seamlessly navigate their existing health plans with on-demand guidance, all in one intuitive, mobile-first experience.
Powered by Zoe, Healthee’s AI-powered Personal Health Assistant, employees receive tailored insights into coverage, costs, and care options—helping them make smarter decisions that reduce unnecessary healthcare spend.
Healthee also simplifies open enrollment with easy-to-use plan comparison tools, guiding employees to the plans that best fit their needs and expected usage. This drives better plan selection, fewer surprises, and meaningful cost savings for both employees and employers.
For HR teams, Healthee reduces administrative burden by delivering fast, accurate benefits support without changing existing plans. For finance leaders, claims analytics and cost insights provide visibility into utilization trends and key cost drivers, empowering CFOs to optimize plan design and control rising healthcare costs.
The result: confident employees, healthier organizations, and a more cost-effective benefits strategy—right at your fingertips.
Built for benefits managers and HR leaders, Healthee serves as a total benefits administration solution that consolidates 50+ point solutions into one intelligent hub. From FSA and HSA guidance to mental health navigation, telemedicine, and EAP access, Healthee connects every benefit in one place—increasing utilization, reducing cost-per-claim, and eliminating benefits fragmentation. Real-time analytics surface which benefits are underused so managers can reallocate budget strategical
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HealthRules Payer
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.
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I-CAPS
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.
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Integrations
No Integrations at this time
Company Details
Company:
HM Health Solutions
Year Founded:
2014
Headquarters:
United States
Website:
www.hmhs.com
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Product Details
Platforms
Web-Based
Customer Support
Business Hours
Online Support
Enterprise Health Solution Features and Options
Enterprise Health Solution User Reviews
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