Alternatives to PLEXIS Payer Platforms

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.

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.

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

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.

HealthAxis provides integrated solutions to payers, providers, and health organizations. These integrated solutions include an advanced claims processing system, TPA services, and actionable analytics. We simplify operations and improve patient and client outcomes. Healthcare is becoming more technologically connected, but it is still hindered by legacy technology, coordination problems, and information management. We aim to bring innovation to those who are struggling with these issues. Our client philosophy is to be a complete business partner. HealthAxis believes that our success is not based on selling our solutions, but rather on our business partners' continued success and growth. We empower our partners to bring value to the communities that they serve. We thrive with them as they grow their membership and expand their scope. Each member of our team is aware of their responsibility to help our partners realize their potential.

Creating breakthrough clinical and administrative results. Evolent Care Partners, Midwest healthcare system was ranked third in the country for total shared savings and percentage savings off benchmark. Evolent Care Partners provides independent primary care physicians with the capital, resources, and financial risk to be successful within two-sided payer contracts. New Century Health provides cost- and quality improvement in oncology, and cardiology. It uses clinical evidence to guide care decisions that can be supported by both payers as well as providers. Evolent Health Services streamlines health plan operations with comprehensive services that are powered through a modern, integrated platform and a true strategic partner model. Get insights and news about value-based care, population and health plan administration, and other topics related to health care transformation.

DataGenix was founded in 2000 and is committed to providing TPAs, adjusters, insurance companies and other entities with modern claims processing solutions. We know that claims processing and managing health benefits can be complicated. Our ClaimScape software automates the entire adjudication process so that your business doesn't suffer any losses. Our Claims software and business are designed to solve the problems that prevent you from providing a superior customer experience for your clientele. Our software products can help your business grow in the most modern ways, keeping in mind current trends and requirements. We have earned the trust of top TPAs across the country and are ready to serve you more.

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.

Vitech's cloud-native management, engagement and analytics platform V3locity® is a transformative suite that provides full life cycle business functionality as well as robust enterprise capabilities. It combines core administration with a new digital experience. Its modular design enables flexible, agile deployment strategies. V3locity uses a cloud-native architecture to provide a solution that is unmatched in security, scalability and resilience.

Innovator, connector, and leader in the insurance industry. We offer the UK's most comprehensive straight-through processing platform. Find out how our digital platform can help you meet your business needs. A digital experience that is seamless and agile will drive business transformation. Improved productivity is possible through the use of adviser and consumer self-service tools. Continual engagement with customers will result in a higher customer lifetime value. Customers and Adviser Portals allow customers to access policy documentation and make changes digitally in real-time. The components cover every aspect of the user experience, including full reinsurance reporting and integration with external portals and automated and clerical Underwriting. Flexible deployment - from complete deployment of the SSG Digital platform to individual components that can be integrated (e.g. Only underwriting, New Business only

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.

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.

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.

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.

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.

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.

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.

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.

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.

Anagram Prosper gives money back to your patients -- at no cost for your practice. You can increase your margins and delight your patients. We partnered with top vendors to create wholesale price lists that better fit your needs and those of your patients. Rebate on products you already own. Incentivize your patients, increase conversions, and earn more revenue. Anagram Prosper allows you to save money for your patients without having to offer discounts or lower your margins. Our rebate program will help you increase sales and make your patients happy. Patients don't know what their out-of network benefits are. Anagram Access allows you to determine your patient's eligibility for vision plans in real time. This will maximize your savings. Anagram Access allows you to quickly calculate the amount your patient owes, and how much their vision plans reimburses.

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.

Origami Risk provides integrated SaaS solutions designed to help organizations--insured corporate and public entities, brokers and risk consultants, insurers, third party claims administrators (TPAs), risk pools, and more, transform their approach to managing critical workflows, leveraging analytics, and engaging with stakeholders. Origami Risk has won five consecutive Business Insurance Innovation Awards. This is because we work closely with our clients to create solutions that address real-world problems. Origami Risk was founded in order to provide real-world solutions that are industry-leading for risk professionals all over the world. This continuous effort is reflected in Origami Risk's acceptance of the 2021 European Risk Management Award as Technology Innovation of the Year. Comprehensive, integrated solutions to reduce incidents and hazards.

RMIS is designed to provide insight and results. Empower your employees with the RMIS to drive productivity, reduce total risk costs and deliver insight. Active risk management is the strategy of empowering your employees to manage risk more effectively by leveraging technology which is centralized and connected, scalable and data-driven. Aclaimant’s centralized system connects your risk office with incidents on the ground, allowing you to successfully reduce accidents, claim lag times and case duration. Reduce the cost of your claims by improving prevention and mitigation. This will improve your insuranceability. Automated, mobile-first technology and automation will help you better utilize your superior safety and risk talent. Aclaimant improves the morale and retention of your team and keeps them focused. Access case studies and other content to learn how to put the Aclaimant platform into action for you and your staff.

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.

The Whitespace Platform is a digital platform that connects global (re)insurance markets. Whitespace is entirely data-driven. Digital data can be used to transfer risk (not Word or PDF documents) and transform your business. The possibilities are limitless. Brokers and Carriers can reap the benefits of increased speed, accuracy, availability, as well as the quantity of in-depth information for risk analysis. Insurers act in the best interests of their customers. A digital connection can provide instant access to the risk placement, faster payments, and quicker responses to claims. Whitespace supports the entire process from start to finish. Brokers and underwriters can create risk submissions, collaborate and sign contracts, communicate through real-time instant messaging and request and provide quotes.

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.

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.

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.

HM Health Solutions offers a complete solution for health plans. The Enterprise Health Solution is a comprehensive platform that manages health plans. It provides the support you need and the business outcomes you desire. Platform applications and tools manage functions such as enrollment, billing, claims, provider management, customer service, and billing. The Enterprise Health Solution (EHS), which can seamlessly move your member from enrollment to claims payment, is the only end-to-end proven solution. Others claim to offer a fully integrated solution. They don't mention that you might need to order all modules in order to achieve this integration. The Enterprise Health Solution has always been focused on health plan administration. Our expertise in the area of health plan payers is unmatched by any other company.

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.

myClaimStatus is the best tool for your staff to save time and reduce waste. You can get real-time, actionable information about all your claims. myClaimStatus's suite data tools makes it easier to reconcile claims faster. It doesn't really matter how small or large you are. MyClaimStatus allows you to save more on every claim. Are you efficient in your work? MedX medical claims services use robotic process automation in order to maximize workflow efficiency. You can easily reconcile reimbursement rates and your contracted amount to ensure you get what you deserve. You can drill down to see real-time data on every healthcare claim from any payer, regardless of the dollar amount. This is not your typical healthcare claims processing software. Optimize AR follow up activities to work by exception, and get more done in a shorter time.

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

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.

Noyo connects and simplifies employee benefits with modern, API-powered data infrastructure. Integrate with Noyo to unlock a whole new world of benefits. Connect quickly to Noyo's APIs to activate fast, accurate data transfer with insurance carriers. Customers will be impressed by Noyo's powerful automation, real time visibility and reliable data. Noyo is the only API that covers all aspects of benefits administration. You can quickly add new groups to the carrier's system, and then confirm enrollment can start. Transmit transactions, receive confirmations and automate accuracy using APIs for member modifications. To eliminate manual work and ensure reliable coverage, process and confirm renewals using API. Digital enrollment can be transformed with industry-leading sync capabilities and APIs that are accessible to partners. A flexible, one-of-many API solution that plugs in to existing systems allows you to get up and running quickly.

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.

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.

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.

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

Will your claims service provider rise to the occasion when the unthinkable happens? Claims Management is a way for GB to fulfill all the promises and potentials of the entire insurance industry. It is the moment when we are called to do more than just making good. We are called to do more and make it better. This call has been answered every day for more than 50 years. It is in our DNA to do more than what is expected. People are at the center of everything we do. We serve people and have a very special person who makes it happen. Our RMs are among the most engaged and empowered in the business. Each one is committed to delivering a superior result. They have proven it time and again. They do it with a spirit that we call Own the End result. To make better decisions earlier in every claim's life. To identify and deliver the correct resources at the right time and place.

The transaction costs of vouchers are reduced by efficient checks, integrated expertise, and high levels of automation. Sumex Core is the foundation for automated electronic invoice verification. It includes the business components and workflows that can be assembled and parameterized in modular fashion. Effective invoice verification is possible only if the reference data and tariff are current and accurate. Sumex reference data are compiled from publicly accessible sources, processed in a timely fashion, and made available on Sumex tariff server. The data can also be accessed by experts within the context of current billing. DRG Expert supports the control of billing for services in acute healthcare, as per SwissDRG regulations. DRG Expert provides case data within the context of regulations, includes statistical key figures, and offers what-if analyses.

Users can provide real-time rates, contracts and dealer menus via eRating or eContracting. Users can issue policies with electronic signatures, and present products to customers through their own sales channels or their partners. Our network has 140+ partners that allow dealers to connect to the eMenu and DMS systems of their choice. Our policy administration software allows for billing, commissions and cancellations. This allows for seamless coverage rating, contracting and contract remittance. Integrating with your accounting system allows you to create, manage, modify, and change your agents, dealers and coverages. Your agents also have direct access to our Agent Portal. The F&I software allows the Dealer Principal and Field Representatives to access integrated reports for F&I forecasting, sales, and overall dealership performance in real time with powerful analytics.

Automate the entire claims process, from the initial notice of loss and fraud detection through claims adjudication and settlement. You can address different types of claims differently, such as maturity and death claims, while improving regulatory compliance, and eliminating non-compliant penalty. Data capture, payment tracking and tracking, legal matter processing, monitoring and monitoring all allow for faster, more accurate and effective processing.

Advanced Insurance System (AIS), which is available to all sizes of organizations, is intended to be an out-of the box solution. Customers can also modify and deploy products quickly, while also taking advantage of the wide range of configuration capabilities of the software. This modular integrated system can be used to interface with other platforms or as a complete policy administration solution. It can be used for Personal, Commercial, and Specialty business lines. AIS makes it easy to create new lines. AIS gives agents and insurers the functionality they need to grow their business. AIS provides automation and self-service functionality in a highly competitive market to increase sales and save time. AIS gives you the competitive advantage that you've been searching for.

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.

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

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.

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

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

Benefitexpress was founded by benefits experts and offers industry-leading cloud-based benefits management software, solutions, and services to employers, brokers, and other partners. My Benefit Express™, our fully outsourced solution, simplifies your benefits administration responsibilities. It helps employees make informed decisions and enhances employee engagement and satisfaction. Software and services include a full-service phone center, integrated ACA administration and reimbursement account administration, dependent eligibility audits and total compensation statements. Our clients' success is assured by our commitment to creative problem solving and scalable systems.