Best PayorLink Alternatives in 2024
Find the top alternatives to PayorLink currently available. Compare ratings, reviews, pricing, and features of PayorLink alternatives in 2024. Slashdot lists the best PayorLink alternatives on the market that offer competing products that are similar to PayorLink. Sort through PayorLink alternatives below to make the best choice for your needs
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Service Center
Office Ally
67 RatingsService 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. -
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Virtual Examiner
PCG Software
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. -
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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.
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MyClaimStatus
Medical Payment Exchange
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. -
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ResolvMD
ResolvMD
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). -
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Beagle Labs
Beagle Labs
Streamlining claims from beginning to end. Integrity, technology, and people are the foundations of this platform. A robust platform for interaction between insurance carriers, MGAs and captives. You can manage your files, deploy applications, and organize claims. Beagle understands the unique challenges that insurance service providers and adjusters face when it comes time to handle claims. Our core software functionality is designed for rapid response to claims, cost reduction, and to streamline the process. Our technology provides efficiency and expertise at every stage of the adjustment process. Express inspection and claim responses that reduce liability, and increase efficiency. New policy inspections and policy renewals. Beagle was designed to handle the daily processes. Claims handling is streamlined by leveraging the most recent technologies, allowing for a more efficient solution. -
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Enter
Enter, Inc
Enter gets Providers (doctors and practices & hospitals) paid faster that anyone in history. Enter processes insurance claims and pays within 24 hours. It also automatically communicates and collects patient responsibility using a white label collection engine that includes payment plans. Enter is 30x more efficient at getting claims paid, and 45x quicker at getting patients billed at the exact same cost as existing medical billers. In just one year, we processed over $150 million in claims. Providers have access to a $100mm credit facility. United Healthcare Nevada - Revenue Cycle Management Partner Enter supports a wide range of specialties, including ASC, Orthopedics and Neurology, Dermatology. Emergency Rooms, Behavioral Healthcare, Pain Management, and many more. - Enter works with all government and commercial health insurance carriers. - Enter integrates all EMR/practice management systems. No monthly fees No integration fees. Venture backed by Enter -
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Conexia
Conexia
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. -
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HEALTHsuite
RAM Technologies
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. -
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Aclaimant
Aclaimant
FreeRMIS 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. -
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Total Loss Pro
Vemark
Total loss claims account for around 20% of all collision and liability losses in the auto insurance industry. Too often, total loss operations of carriers lack cohesive digital workflows. This can lead to high costs, customer dissatisfaction, poor visibility, and poor oversight. Vemark's Total Loss ProTM is your solution. It's the only solution that will transform total loss claims processing into a smooth, efficient machine. You can also keep up with the rapid pace and changes in the world. Improved satisfaction and experience for policyholders through faster settlement. Employee morale is higher due to less frustration and fewer tedious processes. Transparency and visibility for data-driven decision making. Total loss claims for autos are more complicated than those for vehicle repairs. Total Loss Pro, a cloud-based software that helps to improve all stages of this complex salvage vehicle workflow, is available. -
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CLAIMExpert
Acrometis
Acrometis' flagship claims processing solution provides unparalleled workflow management. Documents are automatically routed using a configurable rules engine. Acrometis business rules, which are based on claim assessment scoring, claim compensability matching, body part to claim compensationability matching, jurisdictional directives and relatedness scoring, are designed to reduce claim costs and length. CLAIMExpert automatically processes 65 per cent of all incoming medical bills. Documents that require adjuster intervention are flagged for easy review and quick decision making. All incoming documents are processed automatically with no adjuster intervention. In the first year, clients typically see an average of 11 to 23 points improvement in their medical loss. CLAIMExpert has rules for more than 190 document types. This allows you to quickly handle whitemail and other documents that may come across your adjuster's desk. -
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Assurance Reimbursement Management
Change Healthcare
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. -
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MediClaims
WLT Software
$1 one-time paymentWLT'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. -
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I-CAPS
W.O. Comstock & Associates
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. -
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ClaimScape
DataGenix
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. -
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A1 Tracker
A1 Enterprise
$800/month 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. -
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mobile claims
Symbility Solutions
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. -
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Claim Leader
ClaimLeader
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. -
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Hi-Tech Series 3000
Hi-Tech Health
$3500 per monthWith 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. -
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EvoClaim
DWF Group
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. -
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SpyGlass
Beacon Technologies
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. -
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PwC SMART
PwC
PwC SMART (Systematic monitoring and review technology) improves the efficiency and effectiveness in your inpatient and outpatient quality evaluation processes and allows for a mechanism to ensure quality and compliance review. SMART, along with the support of PwC Health Information Advisory will help you monitor coding quality and data quality. SMART Inpatient has over 1,000 pre-defined business rules which help to identify potential coding errors and document improvement opportunities. You can also modify business rules to suit your particular areas of interest. Data analysis and reporting help you assess the performance of your staff and identify education opportunities for Coding, Quality, and Providers. SMART Outpatient improves accuracy and identifies areas for workflow improvement and charge capture issues. It improves regulatory compliance and reduces the risk of incorrect coding. -
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AUSIS (Full-stack Behavioral underwriting) AUSIS allows insurance companies to offer in-depth underwriting, scoring and decisions in real time. AUSIS reduces cost, time, risk, fraud, and increases efficiency, decision power, alternative score, and more. AUSIS increases STP from NSTP. It also allows non-invasive methods to aggregate health data from AQI and Location, Mortality and Social, Photo, Video and Health Devices. Weather, Sanitation, and more. AUSIS can reduce the policy issuance cost by up to 40%
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TotalEclipse
Startech Software
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™. -
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FBCS Enterprise
DSS
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. -
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FINEOS
FINEOS
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. -
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AGO Insurance Software
AGO Insurance Software
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. -
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Origami Risk
Origami Risk
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. -
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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.
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DocuSketch
DocuSketch
$429 per monthAccelerate your scoping, estimation, and cycle time. Create 360deg 360deg photo tours with detailed 3D in less than 20 seconds per room. Floor plans can be generated in as little as 5 hours. With just a few taps on your smartphone, you can get scope of work reports. Estimates that are compliant with insurance can improve your bottom line. You will find everything you need to accurately document, sketch and scope your estimate. Low upfront costs with maximum time savings, and most bottom line improvements. No complex onboarding or training required. Pick it up and get started. A team of professionals is available to help you, including a 24-hour hotline. Our camera is more accurate and has a smaller margin of error than a phone. Years of industry insight fuel our products, and propel your business to the next level. DocuSketch transforms the restoration industry with cutting-edge software, reducing cycle time, increasing profitability, and expediting claim processing to drive growth and assist. -
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Enterprise Health Solution
HM Health Solutions
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. -
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CLAIMSplus
Addiox Technologies
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. -
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SSI Claims Director
SSI Group
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. -
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HealthRules Payer
HealthEdge Software
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. -
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Complete Claims
Complete Health Systems
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. -
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Curacel
Curacel
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. -
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omni:us
omni:us
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. -
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Context 4 Health Plans Suite
Context4 Healthcare
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. -
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PlanXpand
Acero Health Technologies
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. -
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CyberSource Medical
ComCom Systems
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. -
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EvolutionIQ
EvolutionIQ
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. -
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InsurancePlus Software Series
United Systems and Software
USSI is proud that it offers its entire range of professional insurance software solutions. These software solutions are designed to be a complete turnkey administration solution. USSI's comprehensive software solutions will ensure that your insurance company operates at the highest level in a changing and competitive market. USSI's InsurancePlus Individual Life and Health Administration software solution manages the books of business for traditional and new non-traditional Life and Health insurance businesses. Products supported include Whole and term life, interest sensitive, final Expense, annuities, supplemental health, and others. USSI's InsurancePlus Group Life and Health Administration software solution manages the books of business for Group Health insurance providers, Self-Insured Funds and TPA's. The supported plan offerings include Point of Service and Major Medical, Term Life and High Deductible, Traditional Insurance, etc. -
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Evolent Health
Evolent Health
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. -
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ClaimsControl
Claims Control
$400 per yearOur goal is digitization of data exchange between all claim handling participants: insurers and brokers, their customers and loss adjusters. Our platform allows you to account and share your cases or connect your claims system with our API hub to integrate with your partners. To exchange data with your partners, connect your claims system to the API hub. Direct integration of all claims systems cannot be achieved, so information must be exchanged manually. This slows down the process and increases costs. It also complicates claims process automation. ClaimsControl's purpose is to allow digital data exchange between all participants in the insurance claims handling process. Let's discuss any claims management solutions you may have. We can help you exchange data with other systems, or provide our users with your solution. -
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HealthAxis
HealthAxis
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. -
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Coronis Health
Coronis Health
Coronis Health has more than 30 years experience in revenue cycle management and medical billing. We understand the impact that new legislation can have on medical facilities. We're breaking down the No Surprises Act and how it could impact your bottom line as the No Surprises Act goes into effect. Coronis Health, a global healthcare revenue cycle management and medical bill company, offers specialized solutions and global capabilities. Coronis Health combines industry-leading technology with high-touch relationships building to allow healthcare professionals & facilities focus on patient care, financial independence, and financial success. -
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FileHandler Enterprise
JW Software
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. -
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Ventiv Claims
Riskonnect
Reduce costs by administering claims in a way that is unparalleled in efficiency and accuracy. Ventiv is a global leader in risk management, insurance claims, and advanced analytics. Ventiv is helping some of the world's biggest brands with products such as our industry-leading risk analytics solution. -
50
Ebix FACTS
Ebix
$25000 one-time paymentFACTS®, 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.