Alternatives to Valer

Experience a streamlined workflow with real-time transactions integrated into current technology platforms. This approach enables providers and payers to cut down on time and effort by as much as 90% when it comes to benefits and utilization management. By eliminating the opaque nature of the existing benefits and utilization management system, confusion is significantly reduced for patients, providers, and payers alike. With self-learning automation and fewer clicks required, more time can be dedicated to patient care, allowing providers and payers to concentrate on what truly matters. Myndshft addresses the complexities of multiple point solutions by offering a cohesive, end-to-end platform that facilitates immediate interactions among payers, providers, and patients. The platform not only dynamically updates its automated workflows and rules engines based on real-time feedback from provider-payer interactions but also continually adapts to the specific rules utilized by payers. As usage increases, the system becomes increasingly intelligent, drawing from a comprehensive library of thousands of regularly updated rules tailored for national, state, and regional payers, thereby enhancing efficiency and effectiveness in the healthcare landscape. Ultimately, as the technology evolves, it fosters an environment where care delivery can be optimized, benefiting all stakeholders involved.

Veradigm AccelRx offers a complimentary, automated, all-encompassing solution designed to optimize the fulfillment of specialty medications for your patients. By reducing the time it takes to initiate therapy, this system can improve medication adherence and patient outcomes, while also minimizing the administrative burden of phone calls and faxes on your team. AccelRx integrates electronic enrollment, consent, prior authorization, and prescriptions into one seamless platform, enabling your practice to greatly decrease the fulfillment time for specialty drugs across all payers. With just a click, patient information is automatically filled in on enrollment forms and other necessary documents. This user-friendly platform serves as a transformative tool for managing specialty medications effectively. Furthermore, it enhances your ability to oversee a wide range of specialty drugs, including features for electronic prior authorization (ePA), all within your current electronic health record (EHR) system. This comprehensive approach not only streamlines processes but also supports better patient care and operational efficiency.

Utilize automation and advanced intelligence to tackle challenges related to patient access and the revenue cycle while enhancing reimbursements for the care provided. Even with the advancements in AI and automation streamlining patient access and revenue cycle operations, there remains a critical requirement for personnel skilled in revenue cycle management, clinical practices, and compliance to ensure that patients are financially vetted and that services rendered are billed and reimbursed correctly. We offer our clients a comprehensive combination of technology and team support, backed by extensive knowledge of the intricate reimbursement landscape. Drawing insights from billions of transactions processed for prominent healthcare providers and over 1,400 payers nationwide, our technology and team are uniquely equipped to deliver optimal results. Experience faster financial clearance for patients prior to receiving care with our patient access platform, which offers a holistic approach to eligibility verifications, benefit checks, patient payment estimates, and prior authorization approvals, all integrated into a single system. By streamlining these processes, we aim to enhance the overall efficiency of healthcare delivery and financial operations.

Rhyme facilitates a smart integration between payers and providers within the prior authorization process, effectively reclaiming valuable time lost in repetitive communications and redirecting it to benefit the patient. While automating routine tasks is essential (and that's our focus), it doesn't stop there. In situations where the intricacies of clinical decision-making necessitate collaboration between payers and providers, Rhyme ensures your workflow remains streamlined, flexible, and efficient. We have developed the most extensive integrated prior authorization network, moving away from a fragmented system and fostering intelligent cooperation. Our platform boasts robust relationships and connections to EHRs, payers, and benefits managers, all seamlessly integrated. This means no frantic searches, no cumbersome screen-scraping, and no reliance on indirect information. We engage with providers and payers directly within their current systems and workflows, making connections straightforward so that we can adapt to your needs rather than forcing you to change. Prior authorizations are not just an ancillary feature of our platform; they are our core focus, ensuring that we excel in this area and provide exceptional service. By prioritizing these elements, we aim to transform the way prior authorizations are managed and enhance the overall experience for all parties involved.

Managing prior authorization has become an increasing challenge for healthcare providers. Our innovative solution, AuthParency™, utilizes artificial intelligence and machine learning to streamline this process. By implementing this state-of-the-art system, your team can significantly reduce the time spent on prior authorizations by 50%. Furthermore, it seamlessly integrates with all electronic health records (EHR) and practice management platforms. AuthParency is designed to assist in various ways: - Evaluating the tendencies of payers - Shortening the time patients wait for care - Enhancing overall patient health outcomes - Preventing financial losses from services that lack reimbursement - Identifying the burdens of financial toxicity - Analyzing health data across populations - Monitoring health disparities - Supporting pharmaceutical companies in their efforts

Software tailored for your Early Childhood Program. We emphasize functionality so you can prioritize family engagement. Organize information for clients, providers, referral sources, and team members seamlessly. Produce personalized, adaptable reports and alerts. Quickly retrieve schedules, prescriptions, and insurance approvals. Facilitate the creation and submission of electronic, paper, or specialized claim documents. Generate invoices and statements for families effortlessly. Additionally, upload and monitor both electronic and manual responses from payers, ensuring a streamlined process for your program. This ensures that you can maintain focus on what truly matters—supporting families effectively.

HexIQ software offers quick and straightforward access to negotiated rate information, enabling users to search, download, and analyze intricate healthcare reimbursement rates associated with any specific code, payer, provider (NPI), or tax identification number (TIN), thereby allowing them to utilize transparency in coverage requirements for better business decisions and negotiations. Each month, it processes numerous machine-readable files (MRFs) from various payers, meticulously cleaning and enriching the data with relevant provider names, addresses, and network affiliations, and continually updating it to enable users to benchmark their negotiated rates against those of peers within the same specialty and geographic area without the need for cumbersome Excel work. The software's sophisticated search capabilities allow users to filter results by criteria such as code, specialty, state, place of service, payer, NPI, or TIN, with the option to download findings in CSV format for deeper analysis. Furthermore, integrated analytics and visualization tools provide insights into rate distributions, average and mode rates, and contracted provider networks, which help users gain a clearer understanding of market dynamics. This comprehensive approach not only streamlines the process but also empowers healthcare professionals to make informed strategic decisions based on reliable data.

Paradigm Senior Services provides a comprehensive, AI-driven revenue cycle management solution designed specifically for home-care agencies that handle billing for various third-party payers, including the U.S. Department of Veterans Affairs (VA), Medicaid, and several managed-care organizations. The platform automates and enhances each phase of the billing and claims workflow, encompassing tasks such as verifying eligibility and authorizations, managing state- or payer-specific enrollment and credentialing, submitting accurate claims, addressing denials, and reconciling payments. It seamlessly integrates with widely used agency management software and electronic visit verification systems, enabling the scrubbing of shifts, weekly authorization verifications, and efficient payment reconciliations, all of which contribute to a reduction in denials and a lighter administrative load. Additionally, Paradigm offers "back-office as a service" for healthcare providers; this means that even if agencies have their own billing personnel or scheduling applications, Paradigm is equipped to manage claims processing, functioning as a dedicated, expert billing department. This flexibility allows agencies to focus more on patient care while leaving the complexities of billing in the hands of specialists.

The Turquoise Health Enterprise platform offers a wide-ranging array of solutions centered on healthcare price transparency and the management of contracting processes, featuring modules like Clear Rates Data, which compiles an extensive dataset of over a trillion records related to providers, payers, professionals, drugs, and devices for both institutional and professional services. In addition, it incorporates Clear Contracts, a cloud-based application designed to facilitate the creation, negotiation, and storage of contracts for both payers and providers. This platform also provides Compliance+ to aid organizations in adhering to the requirements for machine-readable files and Good Faith Estimate regulations, along with Analytics tools that allow users to benchmark and investigate market-level rate data. Furthermore, it offers Custom Rates extracts specifically designed for niche healthcare segments, Standard Service Packages comprising pre-assembled bundles of frequently performed procedures, and Search and Care Search dashboards that assist in the discovery and comparison of rates. Additionally, the Turquoise Verified program empowers both providers and payers to efficiently publish and manage their price transparency information, ensuring that all stakeholders benefit from accessible and reliable pricing data.

Free Market Health is a pioneering healthcare technology firm focused on enhancing the specialty pharmacy landscape through a care-oriented marketplace platform. The company collaborates with innovative payers and a diverse range of specialty pharmacies to simplify the intricate and often unclear process of specialty medication fulfillment, ensuring that patients can quickly access essential and transformative medications. By automating the creation and validation of submission packs, the platform effectively tackles underlying challenges, promoting transparent and fair access to specialty drug prescriptions while facilitating real-time decision-making. This vibrant marketplace empowers all participants to optimize their resources, seize new opportunities, and achieve a balance between the cost of care and the value it delivers. With an impressive track record, Free Market Health processes over 200,000 specialty drug claims each year, reflecting a staggering 400% growth from the previous year. The company's commitment to innovation and efficiency continues to reshape the way specialty pharmacy services are delivered, ultimately benefiting patients and healthcare providers alike.

Veradigm Payerpath offers a comprehensive suite of revenue cycle management solutions designed to enhance financial performance for healthcare organizations by improving communications with both payers and patients, ultimately increasing practice profitability across various specialties and sizes. By addressing issues such as incomplete information, incorrect coding, and data entry mistakes, the system ensures that claims are submitted cleanly and accurately. It also guarantees that claims are correctly coded, devoid of missing details, and free from errors before submission. With advanced analytical reporting, practices can benchmark their performance against state, national, and specialty peers, enabling them to optimize productivity and boost financial outcomes. Additionally, Veradigm Payerpath helps remind patients about their appointments while confirming their insurance coverage and benefits, streamlining the process. The platform further automates the billing and collection of patient responsibilities, making it easier for practices to manage finances. Notably, Veradigm Payerpath's integrated solutions are agnostic to practice management systems, ensuring seamless compatibility with all major PM platforms, which enhances its versatility in various healthcare settings. This flexibility allows practices to focus more on patient care while efficiently managing their financial operations.

Medical necessity denials represent a significant financial burden for healthcare providers, incurring costs that can reach into the millions annually due to write-offs, along with the expensive labor involved in investigating and contesting these denials while addressing patient inquiries. Conversely, payers also face similar challenges in the claims management process, as they incur expenses from covering unnecessary medical procedures and treatments, as well as the resources dedicated to handling denial appeals, all of which do not contribute to better patient outcomes. Additionally, patients may suffer from excessive copays and other out-of-pocket expenses, coupled with a frustrating healthcare experience due to charges and services that are not warranted. To combat these issues, the ABN Assistant™ from Vālenz® Assurance equips providers with essential prior authorization tools to confirm medical necessity, generate Medicare-compliant Advanced Beneficiary Notices (ABNs) that include estimated costs, and effectively prevent over 90 percent of medical necessity denials by ensuring that the necessity is validated before any care is administered to the patient. By utilizing this system, providers can enhance their financial stability while improving patient satisfaction and care efficiency.

The Eligibility Verification Standard enhances both patient access and billing procedures by allowing staff to efficiently assign and prioritize patients, payers, and tasks throughout the eligibility verification process. This advanced technology surpasses mere eligibility checks by offering a comprehensive dashboard for confirming, managing, and archiving every inquiry made. It accelerates the verification process through automated enrichment, correcting incomplete or improperly formatted transactions from payers. Additionally, staff can conduct multiple eligibility inquiries simultaneously via batch file uploads that swiftly verify Medicaid, Medicare, and commercial coverage. Team members can be easily assigned tasks, follow-up flags can be set, and eligibility documentation can be generated for future use. Managing patients across batches and resolving issues is simplified, requiring just a few clicks. Ultimately, this cloud-based, all-payer health insurance eligibility verification software saves time and enhances coverage accuracy, while empowering staff to handle benefit inquiries in the manner that suits them best, ensuring operational efficiency. With its user-friendly design and powerful capabilities, it transforms the way eligibility verification is approached in healthcare settings.

ScriptMed's specialty pharmacy management software stands out as a frontrunner in the industry, catering to seven of the top ten specialty pharmacy companies in the U.S. It leverages the most extensive dataset available to automatically fill in essential, patient-specific data, which not only speeds up the medication fulfillment process but also enhances the overall quality of care provided. By offering efficient and automated processing throughout the specialty and infusion pharmacy spectrum, it can reduce service costs by as much as 17%. Furthermore, it significantly shortens the time and expenses associated with filling prescriptions through real-time healthcare connectivity, sophisticated analytics, and automation. The software facilitates interventions and outreach efforts by providing immediate insights into various aspects, including patients, prescribers, payers, and medications. Additionally, it features synchronized medical claims processing, allowing multiple steps to occur simultaneously, which greatly expedites the medical billing process. This innovative approach not only transforms operations but also ensures that pharmacies can achieve unparalleled connectivity, functionality, and financial gains in the competitive specialty pharmacy sector. As a result, healthcare providers are better equipped to address patient needs efficiently and effectively.

Provider Passport serves as a comprehensive healthcare management solution that streamlines and automates essential provider management tasks such as payer enrollment, credentialing, privileging, and data management, all powered by its TruMation AI automation engine. By consolidating provider information into cohesive profiles, it efficiently monitors expiring credentials and licenses, tracks sanction databases in real time, and securely shares information with other systems through APIs or standard messaging protocols, significantly minimizing manual data entry and the potential for errors. The credentialing features of Provider Passport facilitate primary source verifications from numerous integrated sources within seconds, support customizable workflows tailored to various provider types, and enhance the onboarding process by automating re-credentialing and approval workflows. Additionally, its AI-driven payer enrollment engine assesses criteria across a multitude of payer plans, streamlining application submissions and follow-ups, ultimately speeding up the enrollment approval process. As a result, healthcare organizations can improve efficiency and accuracy in their provider management processes.

WellSky® CareTend® is a purpose-built healthcare software solution that empowers infusion and specialty pharmacy providers to manage complex workflows with ease. From clinical documentation and inventory control to billing and patient communication, WellSky CareTend offers a unified platform that improves operational efficiency and care delivery. The system features task-based worklists, customizable assessments, and automated follow-up tools to support safe and effective therapy. With advanced interoperability, WellSky CareTend connects seamlessly to EHRs, payers, and delivery networks. Providers benefit from real-time inventory visibility, streamlined claims processing, and scalable patient outreach — all designed to reduce administrative burden and improve outcomes.

Ensure a steady stream of revenue by utilizing a robust platform that accelerates reimbursements through eligibility verification, tracking claims status, conducting audits and appeals, and managing remittances for both government and commercial claims, all integrated into one cohesive system. Take advantage of a sophisticated rules engine that promptly cleanses claims in accordance with the latest CMS and commercial payer regulations, enabling you to rectify any inaccuracies prior to submission. During the claim upload process, confirm eligibility across all payers and identify any flagged issues, allowing for necessary edits before the claims are sent. Reduce the days in accounts receivable by implementing automated workflows for handling audit responses, submitting appeals, and tracking administrative dispute resolutions. Tailor staff workflow assignments based on the specific claim type and required actions. Additionally, automate the submission of secondary claims to prevent timely filing write-offs. Ultimately, enhance your claims revenue through automated workflows that facilitate quicker and more successful audits and appeals, ensuring your organization remains financially healthy. Furthermore, this comprehensive system can adapt to your evolving needs, providing long-term benefits as your operations grow.

Anomaly is an innovative AI-driven platform designed for payer management that empowers healthcare revenue teams to understand their payers as thoroughly as those payers understand them. By revealing hidden behaviors of payers through the analysis of intricate rules and payment trends across millions of healthcare interactions, it enhances operational efficiency. Central to this platform is its Smart Response engine, which perpetually scrutinizes payer logic, adjusts to evolving policies, and integrates its insights into current revenue cycle processes, enabling real-time predictions of denials, support in claims adjustments, and alerts regarding potential revenue threats. Users gain the ability to foresee revenue shortfalls, negotiate more effectively with payers, and proactively address or overturn denials, thereby safeguarding cash flow. This advanced system effectively bridges the gap between providers and payers, transforming complex billing frameworks into practical intelligence that informs daily financial management while also fostering an environment of enhanced strategic decision-making for revenue teams. By empowering users with this level of insight, Anomaly not only improves operational outcomes but also contributes to a more equitable balance in the healthcare financial landscape.

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.

CureAR is an innovative software that leverages artificial intelligence to enhance medical billing and revenue cycle management, catering to in-house billers, billing companies, managed-service providers, and DME companies. This comprehensive solution integrates various functions such as eligibility verification, charge capture, AI-driven coding recommendations, claim scrubbing, electronic claims submission, ERA ingestion, and automated payment posting into one seamless cloud-based platform. It is adaptable to accommodate specific billing rules for different specialties and allows for multi-tenant operations, making it ideal for practices that manage multiple client accounts. Notable Features: AI-driven coding assistance and claim scrubbing: The machine learning system identifies potential coding mistakes and implements payer-specific validation protocols prior to submission. Real-time tracking and notifications for claims: The software monitors claims throughout the submission and adjudication process, highlighting exceptions that require immediate attention. Automated ERA ingestion and posting: By streamlining the handling of electronic remittance advice with customizable reconciliation workflows, the software significantly minimizes the need for manual posting efforts, leading to greater efficiency. Additionally, its user-friendly interface ensures that all team members can easily navigate the system and utilize its features effectively.

EZClaim, a medical billing and scheduling company, offers a feature-rich practice administration system that is specifically designed for small to medium-sized providers offices and outsourced medical billing companies. It can also be integrated with many EMR/EHR vendors. EZClaim Billing can be used by any type of person, including doctors, practice managers, and billing service owners. It simplifies your claims management, from data entry to payment posting. EZClaim supports the following specialties: General Practice, Therapy and Vision, Surgical, Medical Specialties and Home Health Care. The software can also be used to bill other specialties. EZClaim's billing program allows you to create insurance payor lists for Medicare and Medicaid, Tricare, Clearinghouse payer Is, governmental MCOs, auto insurance, worker compensation groups, and other government programs.

VerifyRx is a dynamic prescriber verification solution that prioritizes compliance and is tailored for pharmacies and PBMs, integrating effortlessly into their existing workflows. This system manages millions of transactions daily, ensuring that prescriber information is kept up-to-date in real-time, incorporating data from the Drug Enforcement Administration (DEA), state authorities, and the National Technical Information Service (NTIS) on a daily basis. By functioning within the pharmacy workflow, VerifyRx not only updates comprehensive prescriber data but also performs immediate compliance checks on all prescription transactions before they are sent to payers. This proactive approach aids retail and specialty pharmacies in minimizing regulatory risk by identifying potential errors in claims submissions before medication is dispensed. In doing so, VerifyRx enhances the overall efficiency of pharmacy operations while supporting adherence to regulatory standards.

Reclaim precious hours in your day and save millions with our innovative automated solutions. Connect effortlessly with essential stakeholders—providers, payers, and partners—while gaining access to real-time, precise data that ensures seamless care delivery. We simplify the intricate web of thousands of payer connections, allowing you to initiate quick and straightforward enrollments with ease. Experience the unparalleled capabilities of the cloud like never before. Our centralized command system enables you to manage, store, and share provider information in real-time, ensuring connectivity wherever necessary. Verification of providers is now a hassle-free process; simply make a request, and our platform will expedite it for you, enhancing your operational efficiency. Let us help you streamline your workflow like never before.

Optum AI Marketplace is a meticulously curated platform of AI-driven solutions aimed at revolutionizing healthcare by equipping payers, providers, and partners with innovative tools to enhance outcomes in a more efficient manner. This marketplace encompasses a wide variety of products and services spanning several categories, including patient and member engagement, claims and eligibility, care operations, payment and reimbursement, and analytics. Among its standout offerings is the prior authorization inquiry API, which allows payers to verify a patient’s authorization status instantly, alongside SmartPay Plus, an electronic cashiering platform designed to simplify the payment process for patients and optimize collections. Moreover, Optum Advisory Technology Services lends expert assistance for organizations undergoing digital transformation, covering areas such as system selection, procurement, and the implementation of AI solutions. The marketplace also collaborates with esteemed resellers, including ServiceNow, to deliver state-of-the-art solutions tailored for the healthcare sector. Ultimately, Optum AI Marketplace serves as a vital resource for organizations striving to improve their operational effectiveness and patient care delivery.

Effective collaboration in patient care hinges on continuous connectivity and access to the latest information. It has become increasingly crucial to streamline the exchange of this information with insurers. Availity simplifies the process of working with payers, guiding you from the initial verification of a patient's eligibility to the final resolution of reimbursements. Clinicians desire quick and straightforward access to health plan details. With Availity Essentials, a complimentary solution backed by health plans, providers can benefit from real-time data exchanges with numerous payers they frequently engage with. Additionally, Availity offers a premium option known as Availity Essentials Pro, which aims to improve revenue cycle performance, minimize claim denials, and secure patient payments more effectively. By relying on Availity as your trusted source for payer information, you can dedicate your attention to delivering quality patient care. Their electronic data interchange (EDI) clearinghouse and API solutions enable providers to seamlessly integrate HIPAA transactions along with other essential functionalities into their practice management systems, ultimately enhancing operational efficiency. This comprehensive approach ensures that healthcare providers can maintain focus on their primary mission: patient well-being.

HealthRules® Payer represents a cutting-edge core administrative processing system that offers transformative features for health plans across various types and sizes. For over a decade, health plans utilizing HealthRules Payer have effectively capitalized on market opportunities, maintaining a competitive edge. What sets HealthRules Payer apart from other core administrative solutions is its innovative application of the patented HealthRules Language™, which resembles English and introduces a groundbreaking methodology for configuration, claims management, and information transparency. This system empowers health plans by enabling them to expand, innovate, and outperform their peers more effectively than any other core system available today. As a result, HealthRules Payer not only streamlines operations but also fosters a culture of agility and responsiveness within health organizations.

Streamline your workflow and integrations to eliminate the tedious manual tasks linked with revenue cycle management. With ESO Billing, your team can concentrate on their core strengths, leading to improved productivity. In the current landscape of reimbursements, maximizing efficiency is essential. ESO Billing is designed to save you precious time at every stage of the billing process. Its user interface has been newly revamped for enhanced speed and user-friendliness. You can tailor your workflow according to your business needs, as the task-based workflow advances each claim through its various stages with minimal intervention. Additionally, it provides automatic alerts for any late payments, ensuring you have peace of mind. Our unique payer-specific proprietary audit process guarantees that every claim is complete with all necessary billing details before submission. This meticulous approach results in the industry's lowest rejection rates from clearinghouses and payers. Furthermore, by integrating ESO Health Data Exchange (HDE) and ESO Payer Insights, you can easily access hospital-generated billing data with just a single click, enhancing your operational efficiency even further. This comprehensive solution empowers your team to navigate the complexities of billing with increased confidence and proficiency.

Oracle Health Specialty Practice Management, a component of the Oracle Health suite of clinical and practice management solutions, equips medical practices with essential tools to operate effectively and generate profit. This system is highly customizable and offers seamless integration with user-friendly electronic health records (EHRs), facilitating medical document management, patient appointment scheduling, and health record oversight. With an active internet connection, it enables near real-time tracking of claim statuses. Unlike traditional paper systems, Oracle Health Specialty Practice Management is engineered to expedite the adjudication, payment, and posting of claims, often achieving these processes weeks faster with most insurance providers. Additionally, it boasts features such as patient scheduling, payment tracking, and posting, which collectively enhance overall operational efficiency. By streamlining the scheduling, monitoring, and payment workflows, Oracle Health Specialty Practice Management ultimately supports practices in delivering superior patient care while improving their financial performance.

Reduce expenses, break down data silos, and enhance outcomes for your members with a cohesive, automated provider data solution. symplr Payer serves as a reliable single source of truth for provider data, ensuring it is regularly reconciled and verified against primary sources. This solution significantly boosts data quality, accessibility, and transparency. Additionally, it alleviates provider frustrations by eliminating redundant requests for information. By utilizing symplr Payer as the central hub for provider data across the enterprise, payers can disseminate timely and precise information to various downstream systems. Our comprehensive and adaptable provider data management solution oversees all pre-contract and renewal contract negotiations. You can streamline and standardize your contracting workflows while meticulously capturing contract specifics such as sentinel events, trigger dates, configuration efforts, process steps, fee schedule information, and more. Furthermore, symplr Payer's innovative design enables your organization to effectively merge contracting and credentialing processes into one seamless operation. This integration not only simplifies management but also enhances overall efficiency in handling provider data.

Our services for Provider Enrollment and Credentialing assist healthcare providers in securing and maintaining their enrollment, ensuring that payers have all necessary information to process claims efficiently. We focus on New Provider Enrollment by fostering relationships with new or previously unengaged payers to enhance revenue potential. Our re-credentialing process addresses the requirements of commercial payers and hospital applications, while our Annual Maintenance services include CAQH Maintenance and Attestation, as well as re-validations for both Medicaid programs and managing expiration dates for DEA, licenses, malpractice insurance, and more. Navigating the complexities of credentialing for your healthcare facility can be a daunting task that consumes significant staff resources. As a comprehensive revenue cycle management firm, we recognize the crucial role that provider credentialing plays in maintaining a healthy cash flow. Our credentialing services cater to both new and existing providers, ensuring that all necessary documentation and relationships are in place for seamless operations. By utilizing our expert services, healthcare practices can focus more on delivering quality care rather than getting bogged down by administrative burdens.

SKYGEN's Provider Data Management (PDM) is a responsive solution designed to enhance the management of provider networks and foster better relationships between healthcare payers and providers. This platform not only boosts the capacity of payers to construct effective provider networks but also elevates satisfaction levels for both providers and members while reducing administrative expenses. By leveraging cutting-edge technology, PDM addresses the demands of contemporary, tech-savvy healthcare participants. It streamlines contract acquisition costs through swift, efficient, and paperless provider recruitment and supplemental network rentals. Additionally, the solution lowers credentialing costs and enhances provider satisfaction by facilitating online credentialing processes. By automating provider self-verification, it eliminates costly outreach efforts and ensures that provider data remains accurate and verified for online directories. Ultimately, SKYGEN enables dental and vision connectivity solutions that empower clients to embrace the future with confidence, utilizing technology that fosters unmatched efficiencies and effectiveness in their operations. This innovation positions healthcare organizations to thrive in an ever-evolving landscape.

Enhance your financial performance by centralizing the automation of patient cost estimates, identifying payer underpayment issues, and optimizing contracts all within a single platform. Detect and analyze trends related to insurance company underpayments to ensure your chargemaster is set for maximum efficiency. Delegate investigations and appeals to your team while monitoring their progress seamlessly in one dashboard. Evaluate and compare performance metrics across different payer contracts to negotiate terms more effectively and from a position of strength. Accurately project patient out-of-pocket expenses, instilling confidence for upfront deposits. Facilitate direct online payments for upfront deposits, enhancing patient convenience. Hold insurance providers accountable for the full amounts due, empowering you in contract discussions. Minimize bad debt and reduce the costs associated with collections, while also decreasing the number of days in accounts receivable. This streamlined approach not only improves financial outcomes but also enhances patient satisfaction and trust in your services.

Leveraging AI as a foundational strategy for payers, providers, and pharmacy benefit managers involves developing cloud-based products and platforms that enhance operational efficiency. A "healthcare digital platform" represents the amalgamation of various applications and cutting-edge technologies to deliver customized healthcare solutions that positively influence business results, marking a progressive and expedited shift away from traditional core administration processing systems (CAPS). To gain insights into how digital platforms and emerging technologies can help meet business goals, as well as their effects on healthcare payer key performance indicators (KPIs) and the overall appeal of these platforms, Infosys collaborated with HFS to survey 100 C-suite healthcare payer executives across the United States. This initiative aims to shed light on the evolving landscape of digital healthcare solutions and their potential for transforming industry practices.

Revolutionizing online business-to-business payments, Payer caters to purchases of any scale, providing endless possibilities for businesses aiming to go digital on a global scale. Whether your goals are local, regional, or worldwide, Payer stands out as the essential partner for online B2B transactions, ensuring your payment processes are equipped for the future. We are built for the contemporary landscape of B2B e-commerce, offering automated payment solutions that enhance customer experiences. Our platform is crafted to integrate smoothly into your customers' journeys, granting you full freedom over the user interface. The automation of B2B payments minimizes manual input, benefiting both you and your clients. Additionally, our expertise in online B2B payments allows us to navigate the complexities associated with multiple system providers in your network. By easily integrating with your ERP and accounting systems, Payer helps you lower administrative expenses while streamlining your payment processes effectively. Embrace the future of payments with Payer, where efficiency meets simplicity and innovation.

Enhancing your care quality and increasing referrals can be achieved more effectively through innovative strategies. With the implementation of Value-Based Purchasing (VBP) and the recent Patient-Driven Payment Model (PDPM), having access to actionable and up-to-date performance data for Skilled Nursing Facilities (SNFs) has become crucial. This data plays a vital role in reducing readmission rates, elevating care quality, showcasing value to referral partners and payers, managing high-risk residents efficiently, and successfully navigating the complexities of PDPM and VBP. SHP for Skilled Nursing is a comprehensive web-based program dedicated to performance improvement, allowing you to take a proactive approach in managing readmissions, enhancing functional outcomes, optimizing staff resources, and strengthening your relationships with referral partners and payers alike. By utilizing Strategic Healthcare Programs, healthcare facilities such as home health agencies, hospices, skilled nursing facilities, and hospitals can enhance quality and optimize their overall performance through the provision of real-time actionable analytics, benchmarks, and user-friendly dashboards. This holistic approach not only improves patient care but also fosters better collaboration with referral sources and payers.

Axora AI serves as a comprehensive claims management solution that integrates AI-driven automation with billing proficiency, overseeing all aspects from eligibility verification to payment processing. However, its capabilities extend beyond mere automation; Axora AI proactively mitigates denial risks, adjusts to changes in payer regulations, and focuses on critical tasks, enabling you to enhance revenue recovery with reduced effort. 1. Oversees the complete claims cycle from initiation to completion. 2. Identifies potential denial issues prior to submission. 3. Focuses on actions designed to boost cash flow. 4. Integrates effortlessly with your existing EHR, payer, and financial systems. 5. No need for migrations or interruptions—just more efficient and streamlined payments. 6. This ensures that your organization can operate smoothly while maximizing financial outcomes.

Amazing Charts Practice Management serves as an all-encompassing platform aimed at improving the workflow and operational efficiency of independent medical practices. Created by a physician with firsthand experience, this solution automates a variety of tasks, including the collection of patient demographics, appointment scheduling, and pre-registration of patients while verifying their insurance eligibility. Additionally, it generates insightful analytical reports and assesses patient financial obligations right at the point of care, while also managing insurance payer lists to facilitate timely and accurate billing processes. This aids practices in collecting payments more efficiently. Among its notable features are tools to monitor unpaid claims, a dedicated claims manager to analyze submissions and minimize denials, and an integrated secure connect clearinghouse that provides robust support and quick adjustments to changes from payers. Moreover, the system boasts intelligent, interactive dashboards tailored to specific roles, which automatically prioritize tasks across various departments, thereby enhancing overall productivity in the medical office. This comprehensive approach ensures that practices not only operate smoothly but also remain agile in responding to the evolving challenges in healthcare administration.

Net Health®, Occupational Medicine covers all major hospital programs and independent clinics. Transform workflows and improve multi-payer billing by overcoming protocols. Integrated telehealth technology allows you to provide care anywhere. You can increase efficiency, performance, and outcomes. Only certified EHR and fully integrated software for practice management. Designed to meet the needs both of hospital-owned and independent Occupational Medicine programs. Create a culture that values being an asset to your clients. You can manage detailed employer-specific protocols. Clients have secure self-service access and access to records, reports, and invoices. Manage multiple payers (insurance and employer invoice, Workers' Compensation), feel confident in your Workers Comp documentation, and see at-a glance KPIs to help you refine your revenue strategy.

MMIT (Managed Markets Insight & Technology) provides a robust analytics and healthcare market access platform that consolidates critical data regarding coverage, policy, restrictions, payers, and real-world insights, enabling life sciences and healthcare organizations to navigate the complexities of therapy coverage, reimbursement, and accessibility within the U.S. healthcare landscape. The MMIT Platform acts as a comprehensive resource where users can delve into a variety of integrated solutions, such as formulary intelligence, medical policy insights, payer landscape and enrollment information, tools for coverage searches, API connectivity, and analytics tailored to support commercialization efforts, competitive assessments, and strategies for patient access. Additionally, it offers in-depth analysis of drug coverage statuses, restrictions, payer dynamics, and market segmentation, featuring tools designed to assess patient access hurdles, guide field engagement initiatives, anticipate policy changes, and seamlessly incorporate coverage information. Ultimately, MMIT empowers its users to make informed decisions that enhance their strategic objectives in the healthcare sector.

CureMD is an award-winning provider for specialty EHR and billing services that help optimize efficiency, reduce cost, and improve the patient experience. Our cloud platform allows seamless information exchange across multiple platforms, systems, or organizations. This facilitates greater collaboration, productivity, patient safety, and increased collaboration. # 1 EHR KLAS Research # 1 Billing Services - KLAS Research Top-Rated Customer Service Simple to use - integrated and customizable iPad KIOSK & iPhone EHR

The Patient Experience Platform serves as a targeted survey tool tailored to specific specialties, enabling practices to gather feedback directly from patients and offering trustworthy insights regarding their experiences. By presenting this information on an easy-to-use dashboard, it allows practices to gain a comprehensive understanding of their operations from the viewpoint of their patients. These valuable insights empower practices to enhance their performance, boost patient loyalty, and ultimately increase revenue. This five-star reputation management tool also promotes transparency regarding the quality of care provided by your team, assisting in converting website visitors into actual patients. Additionally, it includes free-text comments that enrich the feedback received, providing further context and nuance to patient opinions. With real-time, actionable metrics, practices can swiftly implement changes based on insights gained. The platform also offers benchmarking by location and physician, measuring the performance of physicians and office staff alike. Overall, it significantly enhances your value proposition, which can be a critical factor in negotiations with payers while simultaneously fostering a culture of continuous improvement. In doing so, it not only elevates patient satisfaction but also strengthens the overall quality of care delivered.

Insurance Discovery enhances financial outcomes by uncovering previously unrecognized billable coverage that providers may not be aware of, thereby minimizing underpayments and uncompensated care. By employing advanced search functionalities, this solution reveals instances where patients possess multiple active payers, which can significantly improve reimbursement prospects. Additionally, it helps to prevent delays in reimbursement and accelerates revenue collection by ensuring that claims are submitted to the correct payers on the first attempt, thanks to more precise coverage details. When utilized with verified demographic information, Insurance Discovery provides reliable coverage and eligibility insights. This modern approach replaces outdated manual methods of insurance discovery with a swift and thorough search that queries numerous databases in mere seconds, yielding detailed and accurate coverage information. Furthermore, it enhances the overall experience for patients and residents by facilitating accurate estimates of out-of-pocket expenses, ultimately contributing to a more favorable financial journey for them. By streamlining these processes, providers can focus more on patient care rather than administrative tasks.

PayerVault empowers businesses and entrepreneurs of all sizes to launch their online ventures and scale them effortlessly. We provide an easy-to-use platform with all the tools you need to succeed in the ecommerce world. Its Features: Easy Website Builder: No Coding Skills Required! Drag-and-drop our website builder to create and customize a beautiful online store. PayerVault integrates payment processing. Accept all major methods of payment securely. Manage payouts, fees, and transactions efficiently. Simplified Delivery: Choose from a variety of self-fulfillment or integration options with popular delivery partners. Keep your customers informed about the status of their packages. Comprehensive KYC Suite - Verify your customers quickly using PAN Card and Aadhaar Card details, Bank Account Details, Driving License and more. Build trust and stop fraud. Actionable Analytics: Gain valuable insight into your business performance by analyzing detailed reports on sales and custo

Easy to create, verify, file and submit your 1099 MISC forms with the Federal & State compliant efiling platform -Tax1099. Trusted by more than 100,000 businesses Join us today! All your payers and companies are accessible in one place. You can file any type of form you need for any payer right from your account. To get started, you can either create multiple payer profiles or import your data. Our guided notice management tool will save you time and make compliance easier. The built-in notice management dashboard makes it easy to organize your communications with IRS and other parties. Our 256-bit bank-grade security measures will protect confidential information. Two-factor authentication can prevent unauthorized access to your data. Add users and give authority to select users. You can restrict or allow users to view all data in your account.

The RCM Cloud® employs a "software as a service" (SaaS) framework designed to modernize the demanding processes of medical billing through digital solutions that minimize manual intervention and enhance workflow via automation. This innovative system not only boosts operational efficiency but also enables the organization to increase its service delivery capabilities while requiring only slight growth in administrative personnel. By investing in this technology, businesses can expand and thrive without the need to significantly increase their workforce. On the administration front, RCM Cloud® and its related services operate on the robust, reliable, and secure medsphere cloud services platform. The RCM Cloud® suite encompasses various modules such as patient and resource scheduling, enterprise registration, real-time payer eligibility verification, contract management, medical records handling, billing processes, claims management, collections for both payer and self-pay, point-of-sale payment processing, and bad debt management, empowering healthcare organizations to revolutionize their revenue cycles effectively. This comprehensive approach not only streamlines operations but also positions healthcare entities for sustained growth in a competitive market.