Alternatives to MediClaims

Service Center by Office Ally is a trusted revenue cycle management platform used by over 65,000 healthcare organizations processing more than 350 million claims annually. With Service Center, providers can verify patient eligibility and benefits, upload and submit claims, correct rejected claims, check claim status, and obtain remits. With no implementation needed, providers can easily submit secure and confidential claims to any payer from any practice management system to streamline their billing processes and financial performance with faster reimbursements.

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.

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.

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.

FACTS®, a family of products, supports multiple lines of business within a single system: Health, Indemnity, TPA, PPO, HMO, PHO, IPA, MSO, Group Administration, COBRA, section 125-Integrated Flexible Benefits, Workers' Compensation with Integrated Managed care for 24-hour coverage. The FACTS®, system infrastructure was built on HIPAA-compliant standards since the inception. FACTS®, is fully committed to providing a clear and simple path to HIPAA compliance - well ahead the federally mandated compliance deadlines. FACTS®, a fully integrated, interactive Internet-based and voice-based system, provides healthcare professionals with 24 x7 access to claims and benefit information. It also allows for real-time transactions like EDI claim uploads.

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.

EMSmart™, claims processing technology, raises the bar and improves your bottom line. EMS IMC's priorities are to use a compliant, accurate, efficient system to manage a complex billing process and maximize your revenue. EMS IMC's new solution, EMSmart™, allows clients to focus on patient care while ensuring that revenue is collected in a compliant way. EMSmart™, our new proprietary claims processing platform, delivers the industry's best rules-based process automation while retaining human judgement at the appropriate points of the revenue cycle process. EMSmart™, our internal processing engine, is now available to you. We are excited to share this information so that you can be confident that your claims are in the best hands possible, both human and machine.

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.

PLEXIS' suite best-in-class apps have a proven track record of providing payers with the advanced functionality they need to support modern core administrative ecosystems. PLEXIS Business apps provide a range of services, including real-time benefit administration and adjudication, automatic EDI transmission, and self-service customer portals. Passport provides essential connectivity between the core admin and claims management engines, PLEXIS business applications, your own apps and existing in-house system. Passport's flexible API layer allows for real-time integration to portals, business apps, and automated workflow toolsets. Connectivity is unlimited. Streamline workflows using a central, modern core administration and claims management platform. To provide superior customer service and a quick ROI, process claims quickly and accurately.

PlanXpand™, Acero's proprietary transaction processor engine, powers all of our products for administrators of health benefits. Clients can leverage this engine to implement Acero products simultaneously or incrementally. Administrators can choose from one of our standard products or PlanXpand™, which allows them to create a custom solution that extends existing system capabilities. Acero's unique integrated solutions feature Service-Oriented Architecture. This allows health benefits administrators and insurers the ability to add functions and features to existing adjudication platforms. Our sophisticated design and engineering allows real-time adjudication for every type of claim in direct interaction with core claims system. This results in faster processing, happier customers, and less need to adjust claims.

FBCS Enterprise is a centralized platform for guiding decisions regarding non-VA Purchased Care to improve Fee Basis Claims Management and adjudication through efficient claim processing.

SpyGlass, our enterprise-class software for managing health claims, is a powerful and flexible solution that allows for fast and accurate claims processing. SpyGlass makes it easy to set up benefits and plans. BenefitDriven is fully integrated with SpyGlass and provides eligibility, contribution accounting, pension management, and payroll management to the Taft-Hartley sector with all the data and processes for Participants as well as Employers. HIPAA Director, our all in one EDI gateway & scheduler acts as a hub, allowing you to connect with vendor partners to help reduce transaction costs, manage batch transfer, and automate transfers. SpyGlass gives you a detailed, panoramic view of your population. You can drill down to more detail. You have access to hundreds of reports, fully customizable dashboards and total control over the system.

The adjudication program is the core of PBM Express. Claims go through hundreds of edits to ensure accurate processing results, regardless how difficult the plan design is. The parameter drive program allows for a flexible architecture that allows clients to customize as required. Laker's innovative software solution delivers superior performance and industry-leading uptime to clients. Laker is a technology leader and continually improves its systems to meet our customers' growing needs. Customers of Laker have the advantage of the most efficient, flexible, and durable system on the market. Laker works closely alongside our customers to develop and test new products that allow them to compete and win new business. Both Laker and our customers have the best interests to make changes to the software quickly and efficiently to allow for this growth.

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.

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.

AGO Insurance Software, Inc. is a leader in software and services for property- and casualty insurance companies. We have provided cost-effective business solutions to insurers of all sizes. Our products include solutions to policy administration, claims processing and accounting. Our software will streamline your business operations, making it more productive, efficient, and profitable. Our system is modular and can be installed as either a complete system or as separate modules that can be licensed separately. This allows for collaboration with legacy systems or third-party systems.

Analytics-driven claims and remittance management software for healthcare providers. It is designed to automate workflows, increase resource utilization, prevent denials and accelerate cash flow. Your first pass claim acceptance rate will increase. Our comprehensive edits package will help you keep up to date with changes in payer rules and regulations. Automated tasks and intuitive workflows that are exception-based will increase productivity. Our flexible, cloud-based technology is available to your staff from any computer. Automated generation of secondary claims and explanations of benefits (EOB), from the primary remittance advisor, will help you manage your secondary claims volume. Predictive artificial intelligence (PAI) helps you focus on the claims that are most urgent. Avoid denials and errors before submission. You can process claims faster. Print and deliver primary paper claims. Collated claims and EOBs can be added for secondary claims.

KMR Claims Processing manager is a state of the art, fully integrated, customizable, claims processing solution for TPAs and Self-Insured. Our system allows for electronic claims, integrates seamlessly with Document Imaging systems, can process debit cards, and is fully HIPAA compliant.

A new and more efficient way to process and settle claims. Modern, end-to–end solutions for settling claims for all lines, including property, liability, workers' compensation, and workers’ compensation insurance. ClaimRuler™, a cloud-based claims management software, is specifically designed for I/A companies and Third-Party administrators, CAT Adjusters and Insurance Carriers, as well as Self-Insureds and Municipalities. The platform allows for end-to-end claims processing. It includes built-in workflows, robust reporting capabilities and a fully automated diary system that streamlines the settlement of claims. ClaimRuler™, was designed to meet the needs of real people within the industry. Its intuitive and functional design makes it easier to work with forms, lists, documents, photos, and other information. ClaimRuler™, which adapts and scales with your organization, can be used by I/A firms, TPAs and insurance carriers, as well as municipalities and self-insured companies.

Our solutions are proven to be successful at Tier 1 carriers and have lower loss costs, lower expenses and higher customer satisfaction. EvolutionIQ is a partnership between highly skilled professional adjusters and a highly specialized predictive guide system that enables the future in claim handling for complex lines. Empowered adjusters can reduce expenses and losses by providing clear prioritization, proactive claim alerts and rich context. A consistent and scalable claim guidance system will reduce the unintended variability in the claims process. This system allows for more efficient use of adjuster resources and less wasted claim reviews. Targeted claim investigations, litigation avoidance, timely claim settlement. Our claims AI harnesses data to provide the tactical guidance your team requires. EvolutionIQ combines unstructured and structured carrier data with third-party data.

The most accurate and powerful solution on the market for claims processing. CyberSource Medical Claims Scanning Solution is a turn-key system for HMOs, PPOs, TPAs, or Self-Funded Organizations. It can be installed at your location to automate data entry for CMS-1500, ADA 2006 UB-04, and enrollment forms. CyberSource uses advanced "intelligent", combined with your business rules to recognize, validate, and format the data from medical claims forms. Fuzzy Matching uses intelligent search to identify the exact match between your provider and member database. The matched data can then be used to verify and correct the medical claim data before it is sent through to adjudication. Combining industry-leading OCR efficiency, business rules and "Fuzzy Matching", results in exceptional accuracy for the data from your medical claim forms.

This product is an all-in-one claims system. The product's primary functions include claims adjudication, claim workflow, and payment disbursement. Flexible design allows for the addition of adjudication modules to be added on a per-line basis. The core functionality of the system is reused for each new line of business. This system makes use of the user-friendly windows screen design and uses a relational database to store data within the system. Powerbuilder is the software platform. It can be used with an SQL database like Sybase or Oracle. This combination of software allows for a client-server based environment that can process large amounts of claims. Installation and training are provided. Source code is included in the license fee. Expert staff can customize the system and tailor it to the client's requirements. All modifications can be made with detailed design and support for acceptance testing.

bestPT is a cloud-based, complete billing and practice management software. BestPT is a cloud-based software solution that allows private practitioners of all sizes to manage their revenue and payments, as well as track claims. BestPT integrates with webPT and Cedaron EHR systems to streamline billing processes, making the office's workflow easier.

ResolvMD is a full-service, experienced medical billing company that processes all types of health service claims (AHCIP, etc.). ResolvMD is a full-service medical billing company that processes all health service claims (AHCIP etc.) on behalf of doctors. Our goal is to make doctors as competent and confident in their billing as they are in the practice. We do this by surfacing data-derived insights, democratized knowledge, and other data-derived insights. We offer the most secure, cost-effective and modern platform for processing claims. Our target audience is physicians (mainly specialists such emergency physicians, urgent care plastic surgeons, anesthesiologists and paediatricians, as well as general surgeons). To process their claims for health services, they need a billing agent. They value efficiency, time, trust and cost. Today, we are targeting Alberta physicians (primarily in Calgary, Edmonton and Medicine Hat, Lethbridge. Okotoks, and any other centre with more than 25,000 people).

Integration into existing claims systems is seamless. Automate processes and reduce costs It is no longer a choice between improving customer experience and saving money. Data driven insights enable you to make better decisions. Automate manual processes Empower your claims personnel. Invest in the happiness of your customers. Integrate incoming claims seamlessly with your insurance core system. Automate claim processing to reduce inefficiencies and increase customer satisfaction.

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.

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.

CoreLogic modernizes global property and casualty insurance with flexible, collaborative, and secure claims estimation technologies. We create world-class experiences that simplify life and improve business. Claims Connect™, a CoreLogic®, streamlines the claims process by creating an integrated digital ecosystem. Transform your workflow to ensure that your customer's claims can be resolved quickly and accurately. All information is stored securely on one platform, and can be accessed by all claimants. There is no need to switch between different software programs to edit or review claim information. Claims Connect automatically syncs with Claims Connect to allow everyone to instantly see any changes or create estimates. Your claims resolution will be easier, quicker, and more efficient if everyone involved is up-to-date with the information they require, when they need it.

A claim is the most significant interaction in insurance. It's the moment of truth both for policyholders and insurers. ClaimsXPress gives insurers the opportunity to provide unique experiences that lead to positive results. Insurers can differentiate themselves from others in any market by offering a claims service. ClaimsXPress helps insurers improve the claims experience, build customer loyalty, and attract more business from distributor channel partners. Companies that are agile know they can grow faster by using efficient processes and systems that can scale. ClaimsXPress was designed to support insurers' growth. In claims response and data access, speed is important. ClaimsXPress excels in both areas, allowing users to achieve their goals faster.

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.

To win and satisfy today's empowered customers, you need the right process foundations to support your digital business. Fadata's connected solutions will keep you in the game. Today's insurers are searching for the right digital business foundations. This includes the ability to quickly respond to new business opportunities, easy connectivity, and other capabilities that will help them stay ahead. Fadata's insurance platform, INSIS (Insurance Process Platform) is the most comprehensive and comprehensive solution across all major lines. INSIS allows you to release products faster, increase engagement with customers and partners, speed up processes, improve operational control and compliance, and make them more efficient. All capabilities are integrated on one platform that is highly flexible.

Waystar offers market-leading technology that streamlines and unifies revenue cycle. Their cloud-based platform streamlines workflows, improves financials for all healthcare providers and provides more transparency to the patient's financial experience. Waystar has been ranked best in KLAS for Claims & Clearinghouse every year since 2010. It has also received #1 rankings in Black Book™, surveys since 2012, and the Frost & Sullivan North America Customer Valu Leadership Award for ambulatory RCM service in 2019. Waystar is used by over 450,000 providers, 750 hospitals and 5,000 plans. It integrates with all major HIS/PM systems. Waystar.com and @waystar on Twitter provide more information.

Claim Leader is a technology company that develops and delivers technology solutions to automate communication and workflow processes within the business enterprise of insurance claim organizations. Our software solutions simplify your operations while enhancing productivity with an integrated web platform. Claim Leader systems' feature-rich modules simplify the workflow for both field staff and internal administrators. Management tools enable internal users to assign tasks to field staff, organize workload, identify files for review, and streamline workflow.

Venue™, Claims Management for Independent Adjusters, provides complete management of the entire claims processing process. Venue™, whether you are an adjust firm, third party administrator, insurance carrier or self-insured organisation, is the right tool for you. The user-configurable interface allows clients to customize the claim system in their own way. A built-in web service interface allows for batch or real-time data import, update, and export to virtually all third-party data sharing sources of ALL claim-related data. Integration with billing and policy systems allows for real-time synchronization of all policy-related details. This may include important policy dates and flags like active fraud investigation or assumed policy. Comprehensive capabilities for all aspects of claims processing, including recovery and claim payments, contact management, reserves tracking, reserve tracking, contact management and excess and trust accounts.

Claims Manager is a complete, integrated RIMS system that streamlines your process from FNOL through settlement. Unique, configurable business rules engine automates workflow. It reduces duplicate and manual work, saves time, improves outcomes, and increases the value for all parties. Claims Manager's integrated solutions simplify workflow by allowing you to manage, adjust, and report on your property and casualty insurance claims. Claims Manager is an easy-to-use Risk Management Information System that provides tomorrow's solutions. Its intuitive interface seamlessly integrates into an automated workflow that can be accessed from any device, anytime, anywhere. It allows you to easily capture, benchmark and administer claims for all lines property and casualty insurance.

FileHandler Enterprise helps TPAs, insurance carriers, public entities and self-insured organizations automate processes and improve efficiency. Our software keeps you on track with automation and customization, creating a standard claims management process for your business. From implementation to continuous, dedicated support through our Quality Assurance and Implementation Team Members, our goal is to deliver our client partners an effective business management tool, empowering them to automate workflows and increase productivity throughout their business cycle. FileHandler Enterprise allows businesses to facilitate integration with several third-party applications. We ensure that our software works well with preexisting systems in an essential part of our goal at JW Software; helping create customized third-party integrations for your preexisting ISOs, state systems, insurance systems, and much more. FileHandler Enterprise™ software will help you manage and close claims quickly, process payments to parties or vendors, and provide advanced reporting necessary to manage your business.

Virtual diagramming, voice annotation and photo documentation are all available in your palm. It is quick and easy to capture claim information onsite, eliminating the need for followup visits. This also gives policyholders a great opportunity to be involved in the settlement process. In just a few steps, adjusters can estimate, document, and close a claim. This allows for a quicker, more efficient, and more accurate claim settlement. Mobile Claims makes it possible to settle claims onsite with onsite estimates. Our algorithms, which are logic-based questionnaires that generate loss-specific estimates in fraction of the time it takes to build standard estimates, can be applied to create custom estimates in a fraction the time. It is easy to integrate, train and use. The cost of changing is virtually eliminated, which has huge benefits for carriers, adjusters and contractors as well as policyholders. Fully equipped with aerial imagery/measurement and 3D virtual diagramming, geospatial visualizations, video collaboration, contents, and so on.

CaseworksPro is a web-based, affordable claims administration system that can be used to support a wide variety of claim processing needs. CaseworksPro was developed by Insurance Technology Solutions and is designed for carrier claims departments, self insured retentions (SIRs), and third-party administrators. This simple-to-use software offers many features, including SIR client-centric workflows and policy data capture, oneff and scheduled payment, user-defined access permissions and check printing, electronic reporting, NCCI and ISO code capture.

Our software is built with industry knowledge and expert consulting. This knowledge is used to inform the business processes that are to be integrated into our platform. 360 provides end-to-end claims management transparency and integrity, which allows our clients to lower the total cost of their claims. Our clients get better results by using cost-effective technology that transforms the way they do business. Our software is customizable to meet the needs of our clients. It can also be integrated into existing systems to facilitate integration. This allows for in-house resources to support value-added activities that help businesses differentiate and grow.

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.

QuickCap by MedVision Solutions is an administrative and clinical process management solution that allows users to focus on the business, not paperwork. QuickCap gives users scalable control over their workflows and information, allowing them to work smarter. QuickCap provides users with a customizable dashboard that allows them to control their workflow and automate their processes for speed. QuickCap makes claims processing easier and streamlines it. QuickCap allows users to quickly determine profitability for individual providers using analytics.

Auto insurers require tools to make physical damage claims processing easier, from the first notice (FNOL), to settlement. Mitchell WorkCenter is a modular, open-ended solution that allows you customize the modules and integrations to meet your business needs. You will achieve better results through increased accuracy and efficiency while lowering your total cost of ownership. Our platform allows you to send and receive all information directly into your claims management system. Mitchell WorkCenter integration is simple for IT departments. Mitchell WorkCenter has a track record of completing projects in less than 90 days. There are no two businesses the same. WorkCenter allows you to configure and manage your software according to your business needs. You can access the entire suite or choose specific features that will best fit your claims management workflow.

Startech Software's TotalEclipse™ product offers a fully-featured single-database Claims Management & Medical Bill Review Software Application. TotalEclipse™, the culmination over three years worth of development and testing, was created by real claims adjusters and bill reviewers as well as administration managers who use this critical software every day to do their job. Software is often designed with the user in view. TotalEclipse was developed with our users in mind. The application was built around real-world workflows and focuses on making it easy to access the most important information for the job. Eclipse provides the processing power, functionality, and reporting capabilities that you need to maximize productivity and reduce costs. The single-database backend can be scalable to work with either the Microsoft SQL Server™, or Oracle™.

PayorLink solutions go beyond managing medical claims for employers. They offer a complete platform approach to providing better employee benefits that reduce healthcare costs, promote healthy lifestyles, lifetime health, and increase workforce productivity. Rising employee health costs are a global problem and a growing concern for both providers and payor companies. PayorLink™, which is a system that allows payors to exchange information directly with affiliate providers clinics, medical centres, hospitals, and other healthcare providers, is designed to lower payor health costs, increase staff productivity, and optimize provider claims quality. Enhanced with Employee Health Profiles and Assessment tools to improve staff productivity and wellness.

HealthRules®, Payer is the next-generation core administrative system that offers transformational capabilities for health plans of any size and type. Health plans that have implemented HealthRules Payer for more than 10 years have been able quickly respond to market opportunities and stay ahead of their competitors. HealthRules Payer differs from other core administrative solutions because it uses the patented HealthRules language™, a vernacular similar to English, which delivers a new approach to configurations, claims processing and information transparency. HealthRules Payer transforms health plans that want to grow, innovate, and compete beyond other core systems.

Context4 Health Plans Suite is a modular, cloud-based technology platform that protects the integrity of your health plans and allows you to accurately price them. Our team of certified clinical, dental, and healthcare professionals provides immediate, defensible Fraud, Waste, and Abuse detection. A combination of accurate data and cutting-edge cloud technology creates a defensible and proven medicare reference-based pricing solution (RBP). Professional support is available to ensure compliance and efficiency with more than 100 healthcare data sets. Advanced medical coding software that expedites claim submission and minimizes denials.

IMPACT is our core suite of Healthcare administration software. It supports all aspects of healthcare-related data transactions. Our customers use Impact to manage enrollment, provider contracts and re-pricing, benefit plans, authorizations/referrals, claims payment and the various complications that surround these functions. IMPACT is flexible and offers a wide range of industry-specific features.

Polygonal takes the strengths and rich functionality of previous versions and combines them with the most recent Microsoft VB.Net technology and Business Intelligence technology. This comprehensive solution is able to quickly and efficiently respond to the changing market. Polygonal is a modular, multi-currency software solution for underwriting, policy/claims management, transactions, and reinsurance. It integrates with accounting, messaging, document management, document management, and workflow modules to provide an end-to-end business process that delivers tangible results. Polygonal was designed using City Computers' specialist team. As both solution providers and practitioners, we have many years of experience in the insurance industry.

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.

Authorize, claim processing and payment are available at the point-of-care. Improve care coordination and improve outcomes for lower medical costs while streamlining administrative processes. Engage providers at point of care to share and capture data in real time, resulting in an unprecedented exchange of health information. We work with our clients to develop risk management strategies that produce better outcomes at lower costs. We aim to improve the user experience of everyone in the ecosystem. To optimize clients' resources, we deliver a minimum of a 3:1 ROI. Conexia has created a core technology platform (ONE), which can be customized to meet the different regulatory requirements and operational processes of each client in each geographic region. Our initial implementation is usually an overlay on the existing technology ecosystem of the payer to create real-time processes.