Alternatives to Total Loss Pro

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.

Duck Creek Claims offers a robust solution for managing the claims process, aimed at optimizing each stage of the lifecycle for insurance providers. It automates workflows from the first report through to the final settlement, while also simplifying data analysis via integrated analytics and ensuring compatibility with current systems. Notable features encompass advanced first notice of loss (FNOL) capabilities, automated assignments that consider adjuster expertise and current workloads, immediate access to policy and coverage information, and streamlined workflows for adjusters. This innovative platform significantly boosts operational efficiency and minimizes manual tasks, thus facilitating quicker claims resolutions and enhancing customer satisfaction, all while adhering to the latest regulatory standards. With its comprehensive tools and features, Duck Creek Claims positions insurers to effectively respond to the evolving demands of the insurance landscape.

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.

Auto insurance companies require effective solutions to streamline the processing of physical damage claims from the initial report of loss to final settlement. Mitchell WorkCenter offers a comprehensive, modular system that can be tailored to meet the specific requirements of your business. By enhancing accuracy and efficiency, this platform helps to reduce overall ownership costs while ensuring better outcomes. You can seamlessly exchange information directly with your claims management system, facilitating a smoother workflow. With a history of successful project implementations in under 90 days, your IT team will find integrating with Mitchell WorkCenter to be an easy task. Each business operates differently, and WorkCenter allows for the customization and management of software according to your distinct operational needs. You can either utilize the full suite of features or choose particular tools that align perfectly with your claims management processes, providing flexibility and control. This adaptability ensures that your unique workflow is supported, optimizing your claims handling efficiency.

ALYCE is designed for self-insureds and municipalities. It handles Workers' Compensation, Auto Liability and Auto Property claims. ALYCE's intuitive design features important data elements on the main claim pages, including the financial summary. All other details are available with a quick scroll, or a single click. Multi-tiered infrastructure to meet employer reporting requirements, based upon locations and departments. Recoveries, including salvage and subrogation as well as excess carrier payments. Automated repeating and scheduled payments with diary alerts. Automated diaries based upon events, financial transactions, and time lines. Automatic generation of form letters for claimants, lawyers, or other claim parties

Recordables offers advanced software solutions for managing liability claims, encompassing areas such as General Liability, Auto, Property, and various incidents. Their liability insurance tracking software streamlines the organization of incidents and claims associated with auto, property, and general liability policies. With TrackAbility, users can monitor all liability and risk incidents comprehensively, benefitting from a seamless process that handles injury liability claims from the initial incident to final resolution. The platform allows for the creation of customizable liability claim types based on user-defined criteria, enhancing flexibility and usability. Additionally, safety professionals and field personnel can work together on claims and reports, with the capability to continuously upload images and videos related to incidents or claims. Users gain a thorough perspective of the financial aspects vital for effective claims management, including payments and losses that can be analyzed by individual cases, specific locations, policy details, and other relevant information. This integrated approach not only improves efficiency but also fosters better collaboration and communication among stakeholders involved in the claims process.

Streamline the complete claims process by automating steps from the initial loss notification and fraud detection through to adjudication and final settlement. Enjoy the capability to handle various claim types distinctively, such as death claims and maturity claims, while enhancing adherence to regulations and avoiding penalties for non-compliance. Achieve more efficient and precise processing with features for data collection, payment oversight, salvage and recovery management, legal case processing, and comprehensive monitoring. Ensure effective registration, adjudication, tracking, and oversight of all claim submissions. Utilize integrated and detailed business rules that enable claims to be categorized automatically into “fast track” or “non-fast track” categories. Additionally, you have the option to easily add or adjust stakeholders involved in the process, including garages, assessors, loss adjusters, surveyors, investigators, and claims officers, to further enhance operational efficiency. This comprehensive approach not only simplifies workflows but also fosters collaboration among all parties involved in the claims journey.

Our innovative solutions lead to reduced loss costs, minimized expenses, and improved customer satisfaction, demonstrating their effectiveness with top-tier carriers. EvolutionIQ is at the forefront of revolutionizing the claims handling process for intricate coverage lines, fostering a robust collaboration between adept professional adjusters and a uniquely designed predictive guidance system. By providing clear prioritization, proactive claim alerts, and comprehensive context, empowered adjusters are able to lower losses and costs while enhancing the experience for claimants. This approach also mitigates unnecessary variability in the claims process by implementing a consistent and scalable guidance system. Additionally, it optimizes the deployment of adjuster resources, leading to fewer redundant claim reviews and facilitating targeted investigations that help avoid litigation and ensure timely settlements. Our claims AI systematically gathers and utilizes data to offer the strategic guidance necessary for your team’s success. Furthermore, EvolutionIQ integrates both structured and unstructured data from carriers alongside our exclusive third-party data, enhancing overall operational efficiency and effectiveness. This synergy not only streamlines processes but also positions your organization for greater success in the claims landscape.

With the convenience of virtual diagramming, voice annotation, photo documentation, and comprehensive pricing features, everything you need is at your fingertips. By efficiently and precisely gathering claim information directly at the site, follow-up visits are often rendered unnecessary, allowing for deeper engagement with policyholders during the settlement process. Adjusters can seamlessly document, estimate, and finalize claims in just a few simple steps, resulting in quicker, more efficient, and accurate settlements. The Mobile Claims platform ensures that estimates made on-site can quickly transition into settlements. Utilizing intelligent questionnaires, our technology can create tailored, loss-specific estimates significantly faster than conventional methods. The system is designed for easy integration, training, and usability, drastically reducing the costs associated with change while offering substantial advantages for carriers, adjusters, contractors, and policyholders. Additionally, it comes fully equipped with features such as aerial imagery and measurement, 3D virtual diagramming, geospatial visualization, and video collaboration, making it a comprehensive solution for modern claims processing. Overall, this innovative approach not only enhances productivity but also fosters better communication among all parties involved.

Five Sigma embarked on a quest to empower claims organizations to embrace innovation. Their collection of claims management tools and distinctive platform equips insurers with what is necessary to adapt their claims operations to an ever-evolving environment. By offering a suite of Claims-First Cloud-Native and User-Centric products, Five Sigma enhances the capabilities of adjusters, enabling them to manage claims more effectively and swiftly. Through the automation of routine administrative tasks, adjusters can concentrate on making informed decisions while the system efficiently manages the rest. Introducing Clive™ by Five Sigma, the first AI-driven claims adjuster in the industry, is revolutionizing the claims processing landscape for insurers, MGAs, and TPAs. By harnessing cutting-edge AI and automation, Clive optimizes the entire claims lifecycle, from the First Notice of Loss (FNOL) to the final settlement. This AI agent not only boosts the efficiency of claims handling but also improves accuracy and reduces costs by automating various tasks, ultimately leading to a more streamlined and effective process for all stakeholders involved. In this way, Five Sigma is setting a new standard for the future of claims management.

The process of filing claims can be intricate and essential. Many individuals, over 60%, refrain from submitting claims due to the complicated procedures and the substantial time commitment involved. Artivatic's specialized claims platform caters to various insurance sectors, empowering companies to facilitate digital claims experiences, enable self-processing of claims, automate evaluations, and enhance risk and fraud detection, along with claims disbursement. This platform serves as a comprehensive solution for all your claims requirements, offering end-to-end automation and assessment. Whether it’s auto, health, travel, accidental, death, fire, SME, business, or commercial claims, this platform has you covered. By streamlining the claims process, Artivatic aims to increase efficiency and improve customer satisfaction.

The flagship claims processing solution from Acrometis provides exceptional workflow management by utilizing a configurable rules engine to automatically route documents. This system is built around various elements such as claim assessment scoring, matching body parts to claim compensability, adhering to jurisdictional directives, and scoring relatedness, all aimed at minimizing both the duration and costs associated with claims. Notably, CLAIMExpert can autonomously process 65 percent of incoming medical bills and non-medical documents without requiring any user intervention. Documents that need adjuster review are efficiently flagged and organized to facilitate straightforward decision-making, ensuring that the process remains streamlined. With no need for adjuster involvement for the initial processing, clients often experience an improvement ranging from 11 to 23 points in medical loss within the first year. Furthermore, CLAIMExpert is equipped with rules addressing over 190 different document types, enabling it to swiftly manage whitemail and any other documentation that may arrive at an adjuster’s desk. This comprehensive approach not only enhances efficiency but also significantly impacts the overall claims handling process.

Optimizing the claims process from start to finish is our mission. With a focus on technology, people, and integrity, we offer a comprehensive claims service interaction platform tailored for insurance carriers, MGAs, captives, and self-insured organizations. From deployment to claims organization and advanced file management, everything is easily accessible. At Beagle, we recognize the distinct challenges that insurance service providers and independent adjusters encounter in claims management. Our primary software capabilities are crafted to enhance efficiency, cut costs, and ensure prompt responses to claims submissions. By integrating our technology, we elevate the adjustment process with increased efficiency and professionalism at each stage. Our system facilitates quick claims and inspection replies that mitigate liability and enhance operational productivity. Beagle is adept at managing new policy inspections, policy renewals, and daily loss scenarios, making it a reliable partner for everyday operations. Leveraging the latest technological advancements, we provide streamlined claims handling that promotes faster resolutions and improved service delivery. Our commitment to innovation ensures that we remain at the forefront of the insurance industry.

Introducing a cutting-edge and efficient method for managing and settling insurance claims. This comprehensive, all-in-one solution caters to various types of insurance, including property, liability, and workers’ compensation. ClaimRuler™ is a state-of-the-art cloud-based claims management platform crafted specifically for Independent Adjusters, Third-Party Administrators, CAT Adjusters, Insurance Carriers, Self-Insured entities, and Municipalities. The system facilitates seamless claims processing with integrated guided workflows, extensive reporting features, and an automated diary system that enhances the efficiency of the claims settlement process. Designed with the real-world needs of industry professionals in mind, ClaimRuler™ offers a user-friendly and functional interface, making it easier to manage forms, lists, documents, and images. Whether you are part of an I/A firm, a TPA, an insurance carrier, or a municipality, ClaimRuler™ is flexible and scalable to grow alongside your organization. This adaptability ensures that users can navigate the platform with ease while meeting the evolving demands of the insurance landscape.

Effortlessly incorporate into current claims systems while streamlining automation and minimizing expenses. The dilemma of choosing between cost savings and enhancing customer satisfaction is now a thing of the past. Leverage data-driven insights for superior decision-making and automate tedious tasks to empower your claims staff. Prioritize your customers’ satisfaction by ensuring a smooth connection between incoming claims and your core insurance system. Address inefficiencies in processes through claims automation and witness a remarkable boost in customer contentment. By automating the handling of low to moderate complexity claims, you can significantly lower the incidence of manual intervention. Enhanced triaging and manual assignment of claims have led to a substantial increase in the effectiveness of case teams. The reduction in processing time for the remaining manual claims has enabled real-time settlements in numerous cases. The digital claims journey has been automated through the implementation of FNOL-completeness checks, coverage verifications, and automatic claims file generation, resulting in a more efficient system overall. This transformation not only improves operational efficiency but also cultivates a more robust relationship with clients.

Enable your workforce to enhance productivity and minimize the overall risk costs with a Risk Management Information System (RMIS) designed to provide valuable insights and outcomes. By implementing active risk management, you can empower your team to more effectively tackle risk through a centralized, interconnected, scalable, and data-driven technological framework that yields measurable results. Aclaimant's centralized platform facilitates a link between your risk management department and on-site incidents, significantly reducing the frequency of accidents, the lag time for claims, and the duration of cases. By improving prevention strategies and mitigation efforts, you can lower claim expenses and ultimately enhance your insurability. Moreover, leverage advanced mobile technology and automation to better engage and utilize exceptional risk and safety professionals. Aclaimant not only helps keep your team focused but also boosts employee morale, appeal, and retention. Additionally, you can access a variety of case studies and resources that will provide deeper insights into effectively implementing the Aclaimant platform for the benefit of your organization and its members. This comprehensive approach ensures that your risk management practices are not only efficient but also aligned with the evolving needs of your team.

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.

Our 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.

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.

In the insurance sector, the impact of a claim on long-term business outcomes is unparalleled, serving as a pivotal moment for both insurers and their clients. ClaimsXPress empowers insurers to provide exceptional experiences that yield favorable results. The quality of claims service is a crucial factor that sets insurers apart, regardless of the industry landscape. By improving the claims experience, ClaimsXPress fosters customer loyalty and generates increased business from distribution partners. Agile companies recognize that efficient processes and scalable systems are key to rapid growth. With a focus on the growth trajectory of insurers, ClaimsXPress is tailored to meet this need. The ability to respond swiftly to claims and access crucial data is essential, and ClaimsXPress excels in both aspects, allowing users to fast-track their goals. Ultimately, enhancing the claims process is not just about efficiency; it’s about creating lasting relationships that benefit all stakeholders involved.

The KMR Claims Processing Manager is an advanced, fully integrated, and customizable solution designed for Third Party Administrators (TPAs), Self-Insured entities, and Claims Administrators. This sophisticated system features an all-inclusive Medical and Dental Reimbursement module, supports electronic claim submissions, seamlessly integrates with Document Imaging technologies, offers debit card processing capabilities, and ensures full compliance with HIPAA regulations. Additionally, users can easily tailor the system to meet their specific needs and enhance operational efficiency.

Founded in 2000, DataGenix is dedicated to delivering innovative claims processing solutions to third-party administrators, adjusters, and insurance firms. Recognizing the complexities that can arise in claims processing and health benefits management, our team has developed the sophisticated ClaimScape software designed to streamline the entire adjudication process, ensuring your business remains unaffected by potential losses. Our mission is to tackle the challenges that prevent an exceptional customer experience for your clientele. By aligning our offerings with current trends and demands, we are committed to facilitating your organization's growth through our software solutions. Trusted by leading TPAs nationwide, we are eager to expand our services to a broader audience. As we continue to evolve, we aim to set new standards in the industry.

ClaimLogik ensures seamless connectivity among all parties involved in a property claim, facilitating the process from the initial report of loss to final resolution. This comprehensive property assessment and repair network links everyone engaged in your claim from beginning to end. The platform emphasizes stakeholder management by providing each participant with real-time access to perform tasks and oversee activities in an organized, timely manner while maintaining full transparency. Every stakeholder benefits from tailored workflow modules designed to help them monitor, manage, and complete their responsibilities throughout the claims process. By keeping all parties connected on a single claim, ClaimLogik guarantees complete visibility into the status of the claim for everyone involved. With a clear overview of all actions taken during the entire claim journey, the platform promotes accountability and efficiency. It also features digital contracts between insurers and their supply chains, along with service level agreements that ensure all suppliers and trades meet key performance indicators, thus allowing for effective measurement and comparison of supplier performance. Additionally, automated exception management is in place to address any tasks that fall outside the established service level agreements, ensuring a smooth claims process overall. This holistic approach enables improved collaboration and reduces delays in claim processing, ultimately benefiting all stakeholders.

ClaimPilot delivers an exceptional web-based claims management solution combined with outstanding customer service. Tailored for claims management professionals aiming to expand and efficiently oversee their operations, ClaimPilot ensures a user-friendly experience with essential features and capabilities that enhance visibility into claims and financial data through personalized reporting options. This platform effectively addresses the rising demands for data input with its adaptable functionalities, leading to greater efficiency in claims processing. In contrast to cumbersome, overly complex risk management software or simpler systems that only handle document management, ClaimPilot encompasses all necessary features for comprehensive claims management, including compliance with Lloyd’s standards and workers' compensation functionalities. Furthermore, our esteemed customer service team is dedicated to collaborating with clients to create customized reports and features that cater to their evolving needs. Ultimately, we believe that your success directly influences our success, and we are committed to supporting your growth.

Startech Software’s TotalEclipse™ is a comprehensive Claims Management and Medical Bill Review Software application that operates on a single-database system. After more than three years of rigorous development and testing, this product has been crafted by actual claims adjusters, bill reviewers, and administrative managers who rely on this essential software in their daily operations. While many software developers prioritize user experience, TotalEclipse engages users directly in its development process. This collaborative effort results in an application tailored to real-world workflows, emphasizing easy access to the most frequently required information in the field. TotalEclipse is equipped with the advanced processing capabilities, functionality, and reporting features necessary to enhance productivity while effectively managing expenses. With a backend that supports scalability, it can be utilized on either the Microsoft SQL Server™ or Oracle™ platforms, making it versatile for various organizational needs. Additionally, the software's design reflects a commitment to continuous improvement based on user feedback, ensuring it evolves alongside the industries it serves.

Enhance your claims management process while reducing denials with superior edits and a top-tier clean claim rate. Healthcare organizations need advanced technology to ensure precise claim submissions and swift reimbursements. Claims Director, the claims management solution from SSI, simplifies billing procedures and offers transparency by assisting users throughout the entire electronic claim submission and reconciliation journey. As reimbursement criteria from payers undergo modifications, the system continuously tracks these changes and adapts accordingly. Furthermore, with an extensive array of edits across industry, payer, and provider levels, this solution empowers organizations to maximize their reimbursement efforts effectively. Ultimately, utilizing such a comprehensive tool can significantly improve financial outcomes for health systems.

ClaimBook streamlines the insurance claims process by facilitating quicker settlements, enhancing accountability, and reducing the likelihood of rejections. It is equipped with comprehensive features that cater to all aspects of claims management and evidence submission. Furthermore, ClaimBook promotes international patient care through specialized workflows, thereby fostering medical tourism. The platform includes a built-in Rules Engine that prevents incomplete submissions and ensures that all necessary information and documents are provided. This leads to submissions that are accurate, thorough, and pre-authorized. Additionally, ClaimBook incorporates Smart Data Extraction technology, which can interpret uploaded documents to retrieve pertinent information from a connected Hospital's Information System, eliminating the need for manual data entry. Another valuable feature is Integrated Emailing, which creates a virtual inbox directly within your dashboard, allowing users to compose emails with a familiar design similar to that of Microsoft Outlook. This integration not only enhances productivity but also ensures seamless communication throughout the claims process.

Our software is developed through a foundation of industry knowledge combined with professional consultancy. This expertise shapes the business processes that are integrated within our platform. 360 offers comprehensive transparency and integrity in claims and risk management, enabling clients to reduce their overall claims expenses. By delivering affordable technology, we enhance outcomes for our clients and revolutionize their operational methods. Our software is customizable to meet the unique requirements of each client and is designed for seamless integration with current systems, freeing up internal resources for value-added tasks that help companies stand out and expand in their markets. This focus on adaptability and efficiency allows businesses to thrive in a competitive landscape.

Venue ™ Claims Management for Independent Adjusters offers a complete solution for overseeing the entire claims processing workflow. This system is suitable for various entities, including adjustment firms, third-party administrators, insurance carriers, and self-insured organizations. Users can enjoy a highly customizable interface, enabling significant self-modification of the claims management system to meet their specific needs. The platform includes a built-in web service interface, facilitating real-time or batch data imports, updates, and exports to nearly any external data-sharing source concerning all claim-related information. Furthermore, seamless integration with policy and billing systems ensures real-time synchronization of all policy-related details, which may encompass essential policy dates and alerts, such as ongoing fraud investigations and assumed policies. The system provides thorough capabilities for every dimension of claims processing—spanning claim payments, recovery processes, reserves tracking, contact management, trust accounts, forms templates, and extensive reporting functionalities. Overall, Venue ™ empowers organizations to enhance their claims management efficiency and effectiveness.

Streamline the document processing workflow by eliminating unnecessary time and complexity while enhancing straight-through processing initiatives. Shift Claims Document Decisions is an advanced AI-driven solution that scrutinizes documents to extract pertinent information and constructs a contextual overview of the necessary actions needed to advance claims. Our algorithms have been meticulously designed with a focus on insurance documentation, enabling them to analyze forms with a level of precision that rivals or exceeds that of seasoned human claims adjusters. This solution facilitates the automatic assessment of documents against existing data, thereby forming a comprehensive understanding of each claim and expediting the processing timeline. The industry-focused AI continually evolves, merging claims information with document insights to produce decisions that significantly influence claims outcomes. By reducing the need for manual reviews, the system adeptly identifies complexities and guides handlers toward specific claims elements requiring attention. Our unwavering commitment to the insurance sector drives us to recruit top-tier talent, ensuring our customers receive unparalleled support and expertise in their claims processing journey. Ultimately, this innovation not only enhances efficiency but also improves overall customer satisfaction.

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.

Mercury, developed by Quick Silver Systems, enables insurance providers in the Automobile, Property, and Casualty sectors to efficiently rate, quote, bind, process payments, and manage claims through an online platform. It reduces the volume of customer service inquiries by offering online access to documents, bill payments, and initial loss notifications. This API-driven modular system facilitates smooth integration with both new and existing data sources. The fully digital document generation and completely web-based platform ensure compatibility across all devices. Users can design tailored, event-driven workflows using our intuitive visual workflow designer. Stay informed with the latest data on Written, Earned, and Unearned premiums, while all pages, cards, reports, emails, and more are automatically saved for easy review and sharing with colleagues. Additionally, it supports currency collection in various digital formats, including ACH, EFT, electronic checks, credit cards, and bank cards. A robust information technology framework within an insurance organization must prioritize a system that not only ensures broad accessibility but also enhances operational efficiency. Furthermore, Mercury’s capabilities empower insurers to streamline processes, offering a competitive edge in the evolving insurance landscape.

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.

A risk management solution for property and casualty. All-in-one benchmarking and claims management system that simplifies claims-related processes and makes adjusters' lives more simple. TerraClaim provides two tools to simplify claims-related operations. These tools are powerful enough on their own, but even more so when combined. An innovative cross-industry data analytics and claims benchmarking solution that compares your claims performance to industry peers. This helps you set better goals, manage risk reserves, and improve claim outcomes. The world's best property and casualty claims management software that streamlines your internal processes, improves productivity, drives desired results, and prevents fraud.

WLT’s MediClaims system presents an economical, user-friendly, and highly effective solution for managing benefits and claims. Its rules-based framework combined with integrated EDI functionalities ensures that claims are handled swiftly, simply, and with precision. The system is designed to manage a diverse array of benefits and claims, including Medical, Dental, Vision, Prescription Drugs, Consumer-Driven Healthcare, Disability, and Capitation processing. With WLT's MediClaims, you can easily customize the configuration of your groups to accommodate either a single line of coverage or intricate benefit plans with multiple coverage lines. To achieve operational efficiency, a robust information system is essential, and WLT consistently utilizes cutting-edge technologies, delivering you the most advanced and adaptable systems available in the market. In an ever-evolving healthcare landscape, having such a dynamic claims processing system is crucial for maintaining competitive advantage and ensuring customer satisfaction.

Claims adjudication services cover a range of areas including medical, dental, vision, and prescription claims, as well as short and long-term disability cases. These services can be accessed either on-site with a license or through a hosted application model (ASP). Utilizing Microsoft technology, the system is powered by an SQLServer database paired with a Windows front end. Our customer service is highly regarded, staffed by healthcare claims professionals who boast a minimum of 12 years of industry experience. All support inquiries are recorded, and their statuses can be monitored online. The system features a plan copy and modification tool that facilitates rapid plan implementation. Auto-adjudication is achieved through benefit codes that are constructed using business rules derived from over 25 variables connected to both the claims and the claimants, which are then processed by the adjudication engine. Claims can be submitted in various formats, including scanned images, EDI, or paper submissions. The system is compliant with HIPAA EDI 5010 transaction sets, ensuring secure and efficient processing. Additionally, re-pricing fees and UCR schedules can be pre-loaded into the system prior to their effective dates, while the date-driven logic ensures that re-pricing occurs based on the service date, optimizing the claims processing workflow. The comprehensive nature of this system allows for a more streamlined and efficient claims management experience.

SpyGlass, our advanced software for managing health claims at the enterprise level, presents a robust and adaptable solution for efficient and accurate claims processing. The platform simplifies the setup of benefits and plans significantly. Fully integrated with SpyGlass, BenefitDriven offers eligibility verification, contribution accounting, and pension management specifically tailored for the Taft-Hartley sector, encompassing a comprehensive suite of data and processes for both Participants and Employers. Our all-encompassing EDI gateway and scheduler, HIPAA Director, functions as a central hub, enabling seamless connections with vendor partners to minimize transaction costs, streamline batch transfers, and automate the transfer process. With SpyGlass, you gain an in-depth, panoramic view of your population while also having the capability to drill down to granular details with ease. You can access an extensive selection of unique reports, fully customizable dashboards, and maintain total control over your system, ensuring that you have everything you need at your fingertips to make informed decisions and optimize your operations. In this way, SpyGlass empowers organizations to enhance their efficiency and effectiveness in managing health claims.

ResolvMD is a seasoned full-service medical billing firm that handles all types of health service claims, including AHCIP, for medical practitioners. Our mission is to empower physicians to feel as assured and skilled in their billing practices as they do in their medical expertise by providing data-driven insights and accessible knowledge. We offer the most advanced, affordable, and secure platform available for claims processing in the industry. Our primary audience consists of doctors, particularly specialists like emergency room physicians, urgent care providers, plastic surgeons, anesthesiologists, pediatricians, and general surgeons. These professionals seek a reliable billing partner to manage their health service claims, prioritizing attributes such as time efficiency, trustworthiness, cost-effectiveness, and expertise. Currently, we are focusing on physicians located in Alberta, specifically in cities such as Calgary, Edmonton, Red Deer, Medicine Hat, Lethbridge, Okotoks, and any other area with a population exceeding 25,000, ensuring that we meet the needs of a diverse and growing healthcare community.

Imagine happy, efficient claim handlers, fast, accurate claims resolution, and 5-star rating from policyholders. Our platform is flexible and future-ready, enabling your employees to perform like rockstars and equipping your company with scalable, intuitive processes that will fuel profitable growth. Our clients can reduce the cost of claims by up to 30% by automating and simplifying the process. VCA Software is a highly scalable and integrated platform. VCA Software is a favorite among TPAs as well as adjusting firms due to its robust features at a moderate price point.

The EMSmart™ claims processing technology not only elevates service standards but also enhances your financial performance. At EMS IMC, we are dedicated to maintaining a compliant, precise, and efficient system to navigate the growing intricacies of billing, all while swiftly boosting your revenue. Across the nation, our innovative solution, EMSmart™, has empowered clients to concentrate on what truly matters: delivering exceptional patient care, secure in the knowledge that their revenue is being optimized in a compliant way. Our proprietary claims processing platform, EMSmart™, integrates the best rules-based automation in the industry while ensuring that human judgment is applied at key moments throughout the revenue cycle. Though EMSmart™ serves as our internal processing engine, we are eager to communicate this information to you, confirming that your claims are managed by the finest blend of human expertise and automated efficiency available in the field. Ultimately, EMSmart™ not only streamlines the claims process but also reinforces our commitment to excellence in healthcare revenue management.

FBCS Enterprise serves as a centralized platform that enhances decision-making regarding non-VA Purchased care, ultimately leading to improved management and adjudication of fee basis claims through efficient claims processing. The web-based solution, CTM Plus, optimizes workflows and provides necessary oversight to address challenges related to consults and Return to Clinic (RTC) tracking, ensuring timely patient calls and scheduling. Additionally, purchasing analytics play a crucial role in minimizing costs and waste, fostering greater accountability throughout the system. The automated monitoring of expired and recalled items significantly contributes to patient safety. Moreover, the potential repercussions of delayed or misplaced orders can adversely affect both financial performance and the quality of care provided. Time spent navigating through paper records and digital screens detracts from valuable patient interaction, while the process of verifying every patient's opioid prescriptions can be labor-intensive and complicated. DSS PDMP simplifies this issue by consolidating all necessary checks into a single, straightforward step, ultimately enhancing the efficiency of patient care. This holistic approach to managing care not only streamlines operations but also promotes better health outcomes for patients.

PayorLink solutions provide a holistic platform that goes beyond mere management of medical claims for employers, aiming to enhance employee benefits while simultaneously lowering healthcare expenses, encouraging healthy lifestyles, and boosting workforce productivity. The escalating costs of employee health care are a global issue that raises concerns for both payor organizations and healthcare providers. PayorLink™ is specifically crafted to decrease health expenditures for payors, incentivize employee productivity, and improve the quality of provider claims, largely through effective information exchange between payor entities and affiliated healthcare facilities such as clinics, medical centers, or hospitals. Additionally, it is equipped with tools for Employee Health Profiles and Assessments, which contribute to the realization of wellness and productivity among staff. By focusing on these areas, PayorLink not only addresses immediate financial concerns but also fosters a healthier work environment.

PLEXIS offers a comprehensive suite of top-tier applications designed to equip payers with the advanced capabilities required for contemporary core administrative systems. These applications encompass functionalities such as real-time benefit management, adjudication, automated EDI transmission, and self-service customer portals, ensuring that PLEXIS Business Apps meet all your needs. The Passport feature facilitates crucial connections between core administration and claims management systems, PLEXIS business applications, custom applications, and existing internal systems. Its adaptable API layer allows for real-time integration with various portals, automated workflow tools, and business applications, ensuring that connectivity knows no bounds. By employing this centralized, modern core administration and claims management platform, you can enhance workflows effectively. This approach enables the efficient processing of claims while simplifying the complexities associated with benefit administration, resulting in a swift return on investment and the ability to provide exceptional customer service. Ultimately, PLEXIS empowers organizations to thrive in an increasingly complex healthcare landscape.

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.

When unexpected events occur, will your claims services provider meet the challenge head-on? At GB, we perceive Claims Management as the ultimate realization of the promises and potential inherent in the insurance sector. It is a pivotal moment when we are called not just to rectify situations but to enhance and improve them. For over five decades, we have consistently responded to that call. Going beyond the norm is ingrained in our culture. Our focus is on the individuals we serve, as well as the exceptional members of our team who drive our success. Our Relationship Managers are amongst the most motivated and empowered professionals in the industry. Each one is committed to achieving outstanding outcomes consistently. They embody a philosophy we refer to as Own the Outcome, which emphasizes taking responsibility for making informed decisions early in the claims process. This approach allows us to identify and provide the necessary resources promptly and effectively, ensuring we are always prepared to exceed expectations. Furthermore, our dedication to evolving and improving our services ensures that we remain at the forefront of the claims management industry.

Thoughtful AI presents an all-encompassing, AI-powered approach to managing healthcare revenue cycles (RCM). Featuring advanced AI agents like EVA for verifying eligibility and CAM for handling claims, this platform streamlines even the most intricate and labor-intensive RCM tasks. Aimed at enhancing both efficiency and precision, it lowers operational costs, decreases denial rates, and speeds up the posting of payments. Endorsed by top healthcare organizations, Thoughtful AI ensures smooth integration, promises a return on investment, and effectively cuts down costs associated with collections, all while adhering to HIPAA-compliant security standards and offering performance-based assurances. This innovative solution is transforming the way healthcare providers manage their financial processes.

The Whitespace Platform stands out as a fully digital solution tailored for the global (re)insurance industry. Contracts that are generated and managed through Whitespace consist solely of data. By leveraging digital data for risk transfer instead of traditional formats like Word or PDF files, businesses can unlock the true potential of digital transformation. This shift opens up a world of opportunities, including enhancements in speed, precision, availability, and an expansive array of detailed data for risk assessment, all of which significantly benefit both Brokers and Carriers. Moreover, insurers prioritize the needs of their clients, as a digital interface enables immediate access to risk placements, expedited payments, and quicker claim responses. The comprehensive process is thoroughly supported; with Whitespace, brokers and underwriters can seamlessly create risk submissions, collaborate on contractual agreements, communicate through real-time messaging, request and share quotes, and digitally bind, sign, and endorse (re)insurance contracts, enhancing overall efficiency in the marketplace. Ultimately, this innovative approach not only streamlines operations but also fosters stronger relationships between all parties involved.

Optimize Your Entire Healthcare Data Process. Smart Data Solutions possesses the expertise and tools necessary to enhance both your paper-based and electronic workflows. Our suite of integrated tools for validation, matching, and normalization guarantees the highest quality data, which enhances auto-adjudication and minimizes the need for manual processing. Regardless of whether you're a newcomer to Smart Data Solutions or a long-standing collaborator, our development process is designed to support you throughout your projects to maximize your chances of success. Our dedicated team will take the time to grasp your unique needs and the implications of your workflows, addressing both straightforward and intricate requirements. We prioritize your objectives, focusing on what you aim to achieve and then determining the most effective strategies to reach those goals. Smart Data Solutions delivers comprehensive front-end pre-adjudication services for numerous Payers across the country, ensuring flexibility in our offerings. Whether your requirements are minimal or you demand a fully tailored workflow, Smart Data Solutions is equipped with a diverse range of solutions to meet your needs. Our commitment to excellence sets us apart in the industry.

Accelerate your scoping, estimating, and overall cycle times significantly. Produce intricate 3D, 360° photo tours in less than 20 seconds for each room, and create precise floor plans in as little as five hours. Obtain scope of work reports effortlessly with just a few taps on your mobile device. Enhance your financial performance with estimates that comply with insurance standards. Everything you require and even more is at your fingertips to effectively document, sketch, scope, and estimate. Experience low initial costs while enjoying substantial time savings and enhanced profitability. You can get started in no time, as there is no complicated onboarding or extensive training required; simply pick it up and dive right in. A dedicated team of professionals is readily available by phone, including a 24-hour emergency hotline for immediate assistance. Our camera captures data with greater accuracy and a reduced margin of error compared to smartphone usage. Backed by years of industry experience, our products are designed to propel your business to new heights. DocuSketch revolutionizes restoration companies with innovative solutions, dramatically shortening cycle times, increasing profitability, and streamlining claims to foster growth and support. Additionally, the seamless integration of our technology into your workflow will ensure you stay ahead of the competition.

Accelerated claims processing is achieved through multiple interfaces that seamlessly integrate with your corporate branding. Our digital data environment allows for access from any location at any time, ensuring convenience and flexibility. Health and Life processing is streamlined through advanced systems that cater to your specific processing requirements. We enhance the claims lifecycle to keep pace with the volume of incoming claims, while simultaneously addressing and resolving more complex claims at an unprecedented speed. The process is swift and uninterrupted, eliminating delays in claims processing. CLAIMSplus accelerates the claims journey by collaborating with employers, TPAs, and insurers, utilizing powerful cloud-based processing platforms. Our mission at CLAIMSplus is to refine processes and hasten medical claims through secure, dependable, and efficient electronic claims management solutions. Ultimately, our cutting-edge technology is designed to handle claims promptly and effectively. Feedback from our clients has consistently highlighted that the speed of the claims process is the most critical factor in successful claims management, underscoring the importance of our commitment to efficiency.