Alternatives to PLEXIS Payer Platforms

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.

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.

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.

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.

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.

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.

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.

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

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

Connect everyone to your property claim. ClaimLogik connects everyone involved in a property claim, from the first notice of loss to completion. Property assessment & repair ecosystem. We connect everyone involved in your property claim, from start to finish. Stakeholder Management. ClaimLogik connects all stakeholders in a claim with real-time access. This allows them to complete tasks and manage activities in the right order, at the right time and with complete transparency. All stakeholders have access workflow modules that are customized to allow them to track, manage, and complete tasks throughout the claim. Stay connected. All stakeholders connected to one claim. All stakeholders have complete transparency about the claim status. All activities throughout the claim are within your sight. Digital contracts between the Insurer and the supply chain. Service level agreements with all suppliers. Trades KPI management to compare and measure supplier performance. Automated exception management for tasks that fall outside of SLAs

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.

Claims management software is perfect for customer service, complaints, and claims. Reduce claims processing time, reduce costs per claim, and manage claim loads with intelligent reporting, trend analysis, fraud detection, and intelligent reporting.

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.

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

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.

Employers should spend less time managing the benefits of their group and more time focusing on their core business, which is people. Small groups can be sold, quoted, and maintained without the need for multiple platforms and paper. FormFire makes it easier to manage group benefits for small groups. FormFire's platform simplifies the process of collecting employee data. It also allows brokers to retain and gain more clients. You can instantly quote all available plans, regardless of whether they are ACA or medically underwritten. Employers can make the best decisions about the plans they offer on a digital marketplace, from major medical to pet insurance, with the guidance of a trusted broker. Employees can choose plans online and compare prices and options in real time.

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.

Automate business processes and consolidate information to take control of your business. This will allow you to gain real-time insight into your business environment. Caseblocks is ready-made and flexible enough to be modified as your business needs change. Customers' information is extremely sensitive, including financial and personal information. We invest heavily in technology, education, and monitoring to ensure that your data is kept safe and secure in the Caseblocks cloud. We understand that many companies prefer to keep customer and business information in their own data centers. Caseblocks is available for on-premise installation. Automate custom processes with Caseblocks Cloud to work smarter. Caseblocks Cloud is a modern platform that automates operational business processes. It allows you to quickly configure and roll out important processes.

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.

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.

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.

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.

Insurance is seeing significant changes due to digital technologies. Those who keep up with this evolution will be able to retain a competitive edge. Cloud-native enterprise claims management platforms are replacing traditional claim management tools that required multiple systems, paper files, and manual processes. The Majesco ClaimVantage Claims Management Software L&H platform streamlines claims processing from intake to payment calculation. It also integrates multiple systems to improve information flow across your business. With timely and accurate claim decisions, you can improve customer experience and operational effectiveness. Built on the Salesforce Lightning Platform Majesco ClaimVantage Claims Manager Software for L&H allows insurance companies and TPAs modernize and optimize their claims operations.

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.

HealthRules®, Payor is a next generation core administrative processing system that offers transformational capabilities to all types of health plans. Health plans that use HealthRules Payor have been able, for more than ten year, to respond quickly to market opportunities and keep ahead of their competitors. HealthRules Payor is unique because it uses the patented HealthRules Language™, a vernacular similar to English that provides a revolutionary new approach for configuration, claims processing, and transparency of information. HealthRules Payor is a core system that transforms health plans, allowing them to innovate, grow and compete with other systems.

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.

Claimable claims management software is designed for businesses to manage insurance claims. Reduce admin time and increase your claims handling capabilities. Stop searching shared folders or inboxes. All you need to access your claims data is a few clicks away Your data is safe and secure stored in the cloud. It is accessible from anywhere. No more paper! Prepare for an audit with a detailed history of each claim at hand. Keep track of all your documents so you can access them whenever you need. Filter and report on claims data to increase productivity and keep you informed. To organize and categorize your claims, label them. Keep detailed notes about each claim and share them with your team. You can quickly see which tasks are due and completed by assigning tasks to your team. You can quickly build and manage your contacts for claims and find contacts instantly.

Streamline Your Complete Healthcare Data Workflow. Smart Data Solutions has both the experience and tools to streamline your electronic and paper workflows. Our integrated validation, matching and normalization tools ensure high quality data, increasing auto-adjudication, and decreasing manual processing. Our development process guides you through projects, no matter if you are new to Smart Data Solutions or an existing partner. No matter what your needs are, we will work with your staff to understand them and the impact of your workflows. We believe in focusing your efforts on your goals and what you want to achieve. Then, we will identify the best route to get there.

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.

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.

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™.

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.