Health Plan (Commercial)Health Plan (Medicare)Health Plan (Medicaid)TPAIPAMSOFQHCACOProviders

CORE BENEFIT ADMINISTRATIVE SOLUTIONS

Efficient Technology with Low Ongoing Costs

A mature complement of SaaS based healthcare benefits software solutions for benefits administration and healthcare claims processing including benefits enrollment, member management, billing, claims workflow, auto-adjudication, and consumer-driven health plans allowing access to technology with low ongoing costs and efficient benefit plan administration. Our systems are fully capable of administering all types of health plans including commercial insurance, Medicare, Medicaid, self-funded (TPA or first party payer) plans, IPA’s, and ACO’s. Our systems are also fully integrated with our Front-End systems capability and our web portals allowing for the complete integration of member management and claims processing from claims receipt to claims payment.

Key Benefits

  • Drives high auto-adjudication rates
  • Flexible rules-based and programmable benefit plan administration
  • Manages consumer driven health plans (CDHP)
  • Complex data integration to vendors and HR systems
  • Flexibility for complex benefits plan design

Features

  • Complex Benefit Plan Configuration and Reimbursement Methodologies
  • High Auto-Adjudication for Claims Processing
  • Consumer-Driven Health Plans (CDHP/HRA/HSA)
  • Powerful Online, Real-Time Claims Workflow Engine
  • Integrated Medical Claims Editing and Code Bundling
  • Extensive Provider Database Management Administration
  • Data Integration to Vendors and HR Systems
  • Customer Service Call Tracking Module
  • Comprehensive Provider Management Option
  • Fully Integrated Healthcare Information Technology Services
  • Safe, Secure & Redundant Data Storage
  • Continually Upgraded Claims Processing and Admin Software

WEB-BASED SOLUTIONS

A Powerful Suite

A suite of integrated Web portals enabling enrollment and member management. This includes access for members, dependents, administrators, and providers. HealthAxis web portals are completely configurable and are easily maintained by customers. They offer total flexibility for integration with existing health plan portals, stand-alone. They can also be fully integrated with back-end benefits platforms.

Key Benefits

  • Provides easy 24/7 access
  • Increases productivity
  • Reduces customer service costs/proposal costs

Features

Self-funded Proposals system – The system enables employers, brokers, administrators, insurance companies and MGUs to negotiate and efficiently issue self-funded proposals in a web-based environment.

Employee Enrollment – A flexible user-defined online enrollment solution that includes:

  • Variable Group Support
  • Health/Dental/FSA/Life/Ancillary Product Support
  • Annual/New Hire Enrollment
  • Secure Online Confirmations
  • Eligibility and Business Rules Support
  • HR Portal (Online Document and Forms)
  • Rapid Group Setup

Self Service Suite – Accurate, efficient access, allowing employers, employees and providers to manage benefits online such as:

  • Member Demographics and Eligibility
  • Current Coverage/History
  • Claim Status/History
  • ID Card Request
  • Provider Lookup and Links to PPO Network Manager
  • Online Content Libraries (links and online reference materials)

Broker Proposal Tool – Insured proposal generation from pre-defined plans and rates for brokers


PROVIDER PORTAL SOLUTIONS

  • Appeals and Grievances
  • Document Management Solution
  • Compliance Portal
  • Regulatory Memo Tracking
  • SID Credentialing Portal
  • CTM Tracking Portal
  • DMS
  • OEV
  • OTC
  • PR Activity System
  • PR Utility Portal
  • Provider Directory Portal

BUSINESS PROCESS OUTSOURCING (BPO) SOLUTIONS

Our expertise in various sectors throughout the healthcare landscape will allow you to focus on your core competencies, while we effectively manage your business processes. Our systems are continuously updated and improved to meet and exceed best practices, in order to allow you to avoid distractions from your primary areas of business.

Solutions Include:

  • Appeals & Grievances
  • Claims Administration
  • Credentialing
  • Enrollment
  • Fulfillment
  • IS Reporting
  • Medical & Quality Management
  • Member Communications
  • Member Services
  • Member Maintenance
  • MRA
  • OTC
  • Premium Billing
  • Provider Maintenance
  • Provider Services
  • Provider Communication
  • Revenue Management
  • Risk Management
  • System Configuration
  • Training
  • Utilization Management

SMART FRONT-END SERVICES

A Unique Package

Healthaxis’ Smart Front EndSM is a unique package of products and services, including advanced mailroom services, healthcare claims OCR and data capture, claims repricing, and healthcare claims workflow which markedly enhances auto-adjudication rates. All our healthcare IT solutions are customized based on customer need. Our mailroom, scanning and OCR services can be utilized individually, in combination, or in total.

Key Benefits

  • Higher productivity and lower administrative costs
  • Real-time claims workflow and status monitoring
  • Controls document workflow and activity

Features

  • Document Receipt– Provides functionality for complete customized mailroom services, imaging and EDI.
  • Document Control– Provides a real time workflow monitor to all document processing which includes customer-defined triggers to maintain client-defined objectives.
  • Data Conversion– Delivers OCR and manual conversion through proprietary systems that can be custom configured based on client specifications.
  • Data Validation– Addresses coverage eligibility, postal standardization, SIC and client-defined data fields.
  • Claims Matching– Provides a robust matching platform for network routing and claims pricing.
  • Claims Edits– Utilizes complex medical rules-based technology increasing auto-adjudication rates and benefit savings as well as improving workflow efficiency.
  • Claims Routing– Provides a flexible platform for transmitting claims to networks and other client-defined destinations.
  • Claims Pricing– Offers a configurable Healthaxis claim-pricing engine that reduces cost and turnaround time.

*For optimum performance combine Smart Front EndSM with Provider Management.


PROVIDER MANAGEMENT SERVICES

Proprietary Technology for Provider Managers

A combination of proprietary technologies and services that deliver clean provider data, maintenance and transmission.

Key Benefits:

  • Clean corrupt provider databases
  • Manage all transmission to and from provider database
  • Maintain provider database files and integrity
  • Increase auto-adjudication rates

Features:

  • Unique Provider Data Scrub Technology
  • Provider Transmission Edits
  • Proprietary Matching Technology
  • Extensive Provider Database
  • Provider Validation Process
  • Reports Provider Detail
  • Duplicate Record Identification to Source

POST ADJUDICATION SERVICES

Services that simplify reporting and data analysis, as well as fulfillment and payment.

Key Benefits

  • Lower costs
  • Improve efficiency
  • Decrease distribution time
  • In-depth data analysis

Features

  • Electronic Funds Transfer (EFT) – Leading edge methodology and technology, providing rapid paperless payment to providers and members.
  • Fulfillment and Payment – Through global pricing and economies of scale, output fulfillment documents and payments can be distributed more efficiently.
  • Reporting and Data Analysis – Via a direct interface to customer data, we deliver a set of powerful analytical tools and reports, enabling users to dissect and machinate data to provide critical cost management information.

CORE BENEFIT ADMINISTRATIVE SOLUTIONS

Efficient Technology with Low Ongoing Costs

A mature complement of SaaS based healthcare benefits software solutions for benefits administration and healthcare claims processing including benefits enrollment, member management, billing, claims workflow, auto-adjudication, and consumer-driven health plans allowing access to technology with low ongoing costs and efficient benefit plan administration. Our systems are fully capable of administering all types of health plans including commercial insurance, Medicare, Medicaid, self-funded (TPA or first party payer) plans, IPA’s, and ACO’s. Our systems are also fully integrated with our Front-End systems capability and our web portals allowing for the complete integration of member management and claims processing from claims receipt to claims payment.

Key Benefits

  • Drives high auto-adjudication rates
  • Flexible rules-based and programmable benefit plan administration
  • Manages consumer driven health plans (CDHP)
  • Complex data integration to vendors and HR systems
  • Flexibility for complex benefits plan design

Features

  • Complex Benefit Plan Configuration and Reimbursement Methodologies
  • High Auto-Adjudication for Claims Processing
  • Consumer-Driven Health Plans (CDHP/HRA/HSA)
  • Powerful Online, Real-Time Claims Workflow Engine
  • Integrated Medical Claims Editing and Code Bundling
  • Extensive Provider Database Management Administration
  • Data Integration to Vendors and HR Systems
  • Customer Service Call Tracking Module
  • Comprehensive Provider Management Option
  • Fully Integrated Healthcare Information Technology Services
  • Safe, Secure & Redundant Data Storage
  • Continually Upgraded Claims Processing and Admin Software

WEB-BASED SOLUTIONS

A Powerful Suite

A suite of integrated Web portals enabling enrollment and member management. This includes access for members, dependents, administrators, and providers. HealthAxis web portals are completely configurable and are easily maintained by customers. They offer total flexibility for integration with existing health plan portals, stand-alone. They can also be fully integrated with back-end benefits platforms.

Key Benefits

  • Provides easy 24/7 access
  • Increases productivity
  • Reduces customer service costs/proposal costs

Features

Self-funded Proposals system – The system enables employers, brokers, administrators, insurance companies and MGUs to negotiate and efficiently issue self-funded proposals in a web-based environment.

Employee Enrollment – A flexible user-defined online enrollment solution that includes:

  • Variable Group Support
  • Health/Dental/FSA/Life/Ancillary Product Support
  • Annual/New Hire Enrollment
  • Secure Online Confirmations
  • Eligibility and Business Rules Support
  • HR Portal (Online Document and Forms)
  • Rapid Group Setup

Self Service Suite – Accurate, efficient access, allowing employers, employees and providers to manage benefits online such as:

  • Member Demographics and Eligibility
  • Current Coverage/History
  • Claim Status/History
  • ID Card Request
  • Provider Lookup and Links to PPO Network Manager
  • Online Content Libraries (links and online reference materials)

Broker Proposal Tool – Insured proposal generation from pre-defined plans and rates for brokers


PROVIDER PORTAL SOLUTIONS

  • Appeals and Grievances
  • Document Management Solution
  • Compliance Portal
  • Regulatory Memo Tracking
  • SID Credentialing Portal
  • CTM Tracking Portal
  • DMS
  • OEV
  • OTC
  • PR Activity System
  • PR Utility Portal
  • Provider Directory Portal

BUSINESS PROCESS OUTSOURCING (BPO) SOLUTIONS

Our expertise in various sectors throughout the healthcare landscape will allow you to focus on your core competencies, while we effectively manage your business processes. Our systems are continuously updated and improved to meet and exceed best practices, in order to allow you to avoid distractions from your primary areas of business.

Solutions Include:

  • Appeals & Grievances
  • Claims Administration
  • Credentialing
  • Enrollment
  • Fulfillment
  • IS Reporting
  • Medical & Quality Management
  • Member Communications
  • Member Services
  • Member Maintenance
  • MRA
  • OTC
  • Premium Billing
  • Provider Maintenance
  • Provider Services
  • Provider Communication
  • Revenue Management
  • Risk Management
  • System Configuration
  • Training
  • Utilization Management

SMART FRONT-END SERVICES

A Unique Package

Healthaxis’ Smart Front EndSM is a unique package of products and services, including advanced mailroom services, healthcare claims OCR and data capture, claims repricing, and healthcare claims workflow which markedly enhances auto-adjudication rates. All our healthcare IT solutions are customized based on customer need. Our mailroom, scanning and OCR services can be utilized individually, in combination, or in total.

Key Benefits

  • Higher productivity and lower administrative costs
  • Real-time claims workflow and status monitoring
  • Controls document workflow and activity

Features

  • Document Receipt– Provides functionality for complete customized mailroom services, imaging and EDI.
  • Document Control– Provides a real time workflow monitor to all document processing which includes customer-defined triggers to maintain client-defined objectives.
  • Data Conversion– Delivers OCR and manual conversion through proprietary systems that can be custom configured based on client specifications.
  • Data Validation– Addresses coverage eligibility, postal standardization, SIC and client-defined data fields.
  • Claims Matching– Provides a robust matching platform for network routing and claims pricing.
  • Claims Edits– Utilizes complex medical rules-based technology increasing auto-adjudication rates and benefit savings as well as improving workflow efficiency.
  • Claims Routing– Provides a flexible platform for transmitting claims to networks and other client-defined destinations.
  • Claims Pricing– Offers a configurable Healthaxis claim-pricing engine that reduces cost and turnaround time.

*For optimum performance combine Smart Front EndSM with Provider Management.


PROVIDER MANAGEMENT SERVICES

Proprietary Technology for Provider Managers

A combination of proprietary technologies and services that deliver clean provider data, maintenance and transmission.

Key Benefits:

  • Clean corrupt provider databases
  • Manage all transmission to and from provider database
  • Maintain provider database files and integrity
  • Increase auto-adjudication rates

Features:

  • Unique Provider Data Scrub Technology
  • Provider Transmission Edits
  • Proprietary Matching Technology
  • Extensive Provider Database
  • Provider Validation Process
  • Reports Provider Detail
  • Duplicate Record Identification to Source

POST ADJUDICATION SERVICES

Services that simplify reporting and data analysis, as well as fulfillment and payment.

Key Benefits

  • Lower costs
  • Improve efficiency
  • Decrease distribution time
  • In-depth data analysis

Features

  • Electronic Funds Transfer (EFT) – Leading edge methodology and technology, providing rapid paperless payment to providers and members.
  • Fulfillment and Payment – Through global pricing and economies of scale, output fulfillment documents and payments can be distributed more efficiently.
  • Reporting and Data Analysis – Via a direct interface to customer data, we deliver a set of powerful analytical tools and reports, enabling users to dissect and machinate data to provide critical cost management information.

CORE BENEFIT ADMINISTRATIVE SOLUTIONS

Efficient Technology with Low Ongoing Costs

A mature complement of SaaS based healthcare benefits software solutions for benefits administration and healthcare claims processing including benefits enrollment, member management, billing, claims workflow, auto-adjudication, and consumer-driven health plans allowing access to technology with low ongoing costs and efficient benefit plan administration. Our systems are fully capable of administering all types of health plans including commercial insurance, Medicare, Medicaid, self-funded (TPA or first party payer) plans, IPA’s, and ACO’s. Our systems are also fully integrated with our Front-End systems capability and our web portals allowing for the complete integration of member management and claims processing from claims receipt to claims payment.

Key Benefits

  • Drives high auto-adjudication rates
  • Flexible rules-based and programmable benefit plan administration
  • Manages consumer driven health plans (CDHP)
  • Complex data integration to vendors and HR systems
  • Flexibility for complex benefits plan design

Features

  • Complex Benefit Plan Configuration and Reimbursement Methodologies
  • High Auto-Adjudication for Claims Processing
  • Consumer-Driven Health Plans (CDHP/HRA/HSA)
  • Powerful Online, Real-Time Claims Workflow Engine
  • Integrated Medical Claims Editing and Code Bundling
  • Extensive Provider Database Management Administration
  • Data Integration to Vendors and HR Systems
  • Customer Service Call Tracking Module
  • Comprehensive Provider Management Option
  • Fully Integrated Healthcare Information Technology Services
  • Safe, Secure & Redundant Data Storage
  • Continually Upgraded Claims Processing and Admin Software

WEB-BASED SOLUTIONS

A Powerful Suite

A suite of integrated Web portals enabling enrollment and member management. This includes access for members, dependents, administrators, and providers. HealthAxis web portals are completely configurable and are easily maintained by customers. They offer total flexibility for integration with existing health plan portals, stand-alone. They can also be fully integrated with back-end benefits platforms.

Key Benefits

  • Provides easy 24/7 access
  • Increases productivity
  • Reduces customer service costs/proposal costs

Features

Self-funded Proposals system – The system enables employers, brokers, administrators, insurance companies and MGUs to negotiate and efficiently issue self-funded proposals in a web-based environment.

Employee Enrollment – A flexible user-defined online enrollment solution that includes:

  • Variable Group Support
  • Health/Dental/FSA/Life/Ancillary Product Support
  • Annual/New Hire Enrollment
  • Secure Online Confirmations
  • Eligibility and Business Rules Support
  • HR Portal (Online Document and Forms)
  • Rapid Group Setup

Self Service Suite – Accurate, efficient access, allowing employers, employees and providers to manage benefits online such as:

  • Member Demographics and Eligibility
  • Current Coverage/History
  • Claim Status/History
  • ID Card Request
  • Provider Lookup and Links to PPO Network Manager
  • Online Content Libraries (links and online reference materials)

Broker Proposal Tool – Insured proposal generation from pre-defined plans and rates for brokers


PROVIDER PORTAL SOLUTIONS

  • Appeals and Grievances
  • Document Management Solution
  • Compliance Portal
  • Regulatory Memo Tracking
  • SID Credentialing Portal
  • CTM Tracking Portal
  • DMS
  • OEV
  • OTC
  • PR Activity System
  • PR Utility Portal
  • Provider Directory Portal

BUSINESS PROCESS OUTSOURCING (BPO) SOLUTIONS

Our expertise in various sectors throughout the healthcare landscape will allow you to focus on your core competencies, while we effectively manage your business processes. Our systems are continuously updated and improved to meet and exceed best practices, in order to allow you to avoid distractions from your primary areas of business.

Solutions Include:

  • Appeals & Grievances
  • Claims Administration
  • Credentialing
  • Enrollment
  • Fulfillment
  • IS Reporting
  • Medical & Quality Management
  • Member Communications
  • Member Services
  • Member Maintenance
  • MRA
  • OTC
  • Premium Billing
  • Provider Maintenance
  • Provider Services
  • Provider Communication
  • Revenue Management
  • Risk Management
  • System Configuration
  • Training
  • Utilization Management

SMART FRONT-END SERVICES

A Unique Package

Healthaxis’ Smart Front EndSM is a unique package of products and services, including advanced mailroom services, healthcare claims OCR and data capture, claims repricing, and healthcare claims workflow which markedly enhances auto-adjudication rates. All our healthcare IT solutions are customized based on customer need. Our mailroom, scanning and OCR services can be utilized individually, in combination, or in total.

Key Benefits

  • Higher productivity and lower administrative costs
  • Real-time claims workflow and status monitoring
  • Controls document workflow and activity

Features

  • Document Receipt– Provides functionality for complete customized mailroom services, imaging and EDI.
  • Document Control– Provides a real time workflow monitor to all document processing which includes customer-defined triggers to maintain client-defined objectives.
  • Data Conversion– Delivers OCR and manual conversion through proprietary systems that can be custom configured based on client specifications.
  • Data Validation– Addresses coverage eligibility, postal standardization, SIC and client-defined data fields.
  • Claims Matching– Provides a robust matching platform for network routing and claims pricing.
  • Claims Edits– Utilizes complex medical rules-based technology increasing auto-adjudication rates and benefit savings as well as improving workflow efficiency.
  • Claims Routing– Provides a flexible platform for transmitting claims to networks and other client-defined destinations.
  • Claims Pricing– Offers a configurable Healthaxis claim-pricing engine that reduces cost and turnaround time.

*For optimum performance combine Smart Front EndSM with Provider Management.


PROVIDER MANAGEMENT SERVICES

Proprietary Technology for Provider Managers

A combination of proprietary technologies and services that deliver clean provider data, maintenance and transmission.

Key Benefits:

  • Clean corrupt provider databases
  • Manage all transmission to and from provider database
  • Maintain provider database files and integrity
  • Increase auto-adjudication rates

Features:

  • Unique Provider Data Scrub Technology
  • Provider Transmission Edits
  • Proprietary Matching Technology
  • Extensive Provider Database
  • Provider Validation Process
  • Reports Provider Detail
  • Duplicate Record Identification to Source

POST ADJUDICATION SERVICES

Services that simplify reporting and data analysis, as well as fulfillment and payment.

Key Benefits

  • Lower costs
  • Improve efficiency
  • Decrease distribution time
  • In-depth data analysis

Features

  • Electronic Funds Transfer (EFT) – Leading edge methodology and technology, providing rapid paperless payment to providers and members.
  • Fulfillment and Payment – Through global pricing and economies of scale, output fulfillment documents and payments can be distributed more efficiently.
  • Reporting and Data Analysis – Via a direct interface to customer data, we deliver a set of powerful analytical tools and reports, enabling users to dissect and machinate data to provide critical cost management information.

CORE BENEFIT ADMINISTRATIVE SOLUTIONS

Efficient Technology with Low Ongoing Costs

A mature complement of SaaS based healthcare benefits software solutions for benefits administration and healthcare claims processing including benefits enrollment, member management, billing, claims workflow, auto-adjudication, and consumer-driven health plans allowing access to technology with low ongoing costs and efficient benefit plan administration. Our systems are fully capable of administering all types of health plans including commercial insurance, Medicare, Medicaid, self-funded (TPA or first party payer) plans, IPA’s, and ACO’s. Our systems are also fully integrated with our Front-End systems capability and our web portals allowing for the complete integration of member management and claims processing from claims receipt to claims payment.

Key Benefits

  • Drives high auto-adjudication rates
  • Flexible rules-based and programmable benefit plan administration
  • Manages consumer driven health plans (CDHP)
  • Complex data integration to vendors and HR systems
  • Flexibility for complex benefits plan design

Features

  • Complex Benefit Plan Configuration and Reimbursement Methodologies
  • High Auto-Adjudication for Claims Processing
  • Consumer-Driven Health Plans (CDHP/HRA/HSA)
  • Powerful Online, Real-Time Claims Workflow Engine
  • Integrated Medical Claims Editing and Code Bundling
  • Extensive Provider Database Management Administration
  • Data Integration to Vendors and HR Systems
  • Customer Service Call Tracking Module
  • Comprehensive Provider Management Option
  • Fully Integrated Healthcare Information Technology Services
  • Safe, Secure & Redundant Data Storage
  • Continually Upgraded Claims Processing and Admin Software

WEB-BASED SOLUTIONS

A Powerful Suite

A suite of integrated Web portals enabling enrollment and member management. This includes access for members, dependents, administrators, and providers. HealthAxis web portals are completely configurable and are easily maintained by customers. They offer total flexibility for integration with existing health plan portals, stand-alone. They can also be fully integrated with back-end benefits platforms.

Key Benefits

  • Provides easy 24/7 access
  • Increases productivity
  • Reduces customer service costs/proposal costs

Features

Self-funded Proposals system – The system enables employers, brokers, administrators, insurance companies and MGUs to negotiate and efficiently issue self-funded proposals in a web-based environment.

Employee Enrollment – A flexible user-defined online enrollment solution that includes:

  • Variable Group Support
  • Health/Dental/FSA/Life/Ancillary Product Support
  • Annual/New Hire Enrollment
  • Secure Online Confirmations
  • Eligibility and Business Rules Support
  • HR Portal (Online Document and Forms)
  • Rapid Group Setup

Self Service Suite – Accurate, efficient access, allowing employers, employees and providers to manage benefits online such as:

  • Member Demographics and Eligibility
  • Current Coverage/History
  • Claim Status/History
  • ID Card Request
  • Provider Lookup and Links to PPO Network Manager
  • Online Content Libraries (links and online reference materials)

Broker Proposal Tool – Insured proposal generation from pre-defined plans and rates for brokers


PROVIDER PORTAL SOLUTIONS

  • Appeals and Grievances
  • Document Management Solution
  • Compliance Portal
  • Regulatory Memo Tracking
  • SID Credentialing Portal
  • CTM Tracking Portal
  • DMS
  • OEV
  • OTC
  • PR Activity System
  • PR Utility Portal
  • Provider Directory Portal

BUSINESS PROCESS OUTSOURCING (BPO) SOLUTIONS

Our expertise in various sectors throughout the healthcare landscape will allow you to focus on your core competencies, while we effectively manage your business processes. Our systems are continuously updated and improved to meet and exceed best practices, in order to allow you to avoid distractions from your primary areas of business.

Solutions Include:

  • Appeals & Grievances
  • Claims Administration
  • Credentialing
  • Enrollment
  • Fulfillment
  • IS Reporting
  • Medical & Quality Management
  • Member Communications
  • Member Services
  • Member Maintenance
  • MRA
  • OTC
  • Premium Billing
  • Provider Maintenance
  • Provider Services
  • Provider Communication
  • Revenue Management
  • Risk Management
  • System Configuration
  • Training
  • Utilization Management

SMART FRONT-END SERVICES

A Unique Package

Healthaxis’ Smart Front EndSM is a unique package of products and services, including advanced mailroom services, healthcare claims OCR and data capture, claims repricing, and healthcare claims workflow which markedly enhances auto-adjudication rates. All our healthcare IT solutions are customized based on customer need. Our mailroom, scanning and OCR services can be utilized individually, in combination, or in total.

Key Benefits

  • Higher productivity and lower administrative costs
  • Real-time claims workflow and status monitoring
  • Controls document workflow and activity

Features

  • Document Receipt– Provides functionality for complete customized mailroom services, imaging and EDI.
  • Document Control– Provides a real time workflow monitor to all document processing which includes customer-defined triggers to maintain client-defined objectives.
  • Data Conversion– Delivers OCR and manual conversion through proprietary systems that can be custom configured based on client specifications.
  • Data Validation– Addresses coverage eligibility, postal standardization, SIC and client-defined data fields.
  • Claims Matching– Provides a robust matching platform for network routing and claims pricing.
  • Claims Edits– Utilizes complex medical rules-based technology increasing auto-adjudication rates and benefit savings as well as improving workflow efficiency.
  • Claims Routing– Provides a flexible platform for transmitting claims to networks and other client-defined destinations.
  • Claims Pricing– Offers a configurable Healthaxis claim-pricing engine that reduces cost and turnaround time.

*For optimum performance combine Smart Front EndSM with Provider Management.


PROVIDER MANAGEMENT SERVICES

Proprietary Technology for Provider Managers

A combination of proprietary technologies and services that deliver clean provider data, maintenance and transmission.

Key Benefits:

  • Clean corrupt provider databases
  • Manage all transmission to and from provider database
  • Maintain provider database files and integrity
  • Increase auto-adjudication rates

Features:

  • Unique Provider Data Scrub Technology
  • Provider Transmission Edits
  • Proprietary Matching Technology
  • Extensive Provider Database
  • Provider Validation Process
  • Reports Provider Detail
  • Duplicate Record Identification to Source

POST ADJUDICATION SERVICES

Services that simplify reporting and data analysis, as well as fulfillment and payment.

Key Benefits

  • Lower costs
  • Improve efficiency
  • Decrease distribution time
  • In-depth data analysis

Features

  • Electronic Funds Transfer (EFT) – Leading edge methodology and technology, providing rapid paperless payment to providers and members.
  • Fulfillment and Payment – Through global pricing and economies of scale, output fulfillment documents and payments can be distributed more efficiently.
  • Reporting and Data Analysis – Via a direct interface to customer data, we deliver a set of powerful analytical tools and reports, enabling users to dissect and machinate data to provide critical cost management information.

Fully Delegated IPA & Messenger-Model IPA

CORE BENEFIT ADMINISTRATIVE SOLUTIONS

Efficient Technology with Low Ongoing Costs

A mature complement of SaaS based healthcare benefits software solutions for benefits administration and healthcare claims processing including benefits enrollment, member management, billing, claims workflow, auto-adjudication, and consumer-driven health plans allowing access to technology with low ongoing costs and efficient benefit plan administration. Our systems are fully capable of administering all types of health plans including commercial insurance, Medicare, Medicaid, self-funded (TPA or first party payer) plans, IPA’s, and ACO’s. Our systems are also fully integrated with our Front-End systems capability and our web portals allowing for the complete integration of member management and claims processing from claims receipt to claims payment.

Key Benefits

  • Drives high auto-adjudication rates
  • Flexible rules-based and programmable benefit plan administration
  • Manages consumer driven health plans (CDHP)
  • Complex data integration to vendors and HR systems
  • Flexibility for complex benefits plan design

Features

  • Complex Benefit Plan Configuration and Reimbursement Methodologies
  • High Auto-Adjudication for Claims Processing
  • Consumer-Driven Health Plans (CDHP/HRA/HSA)
  • Powerful Online, Real-Time Claims Workflow Engine
  • Integrated Medical Claims Editing and Code Bundling
  • Extensive Provider Database Management Administration
  • Data Integration to Vendors and HR Systems
  • Customer Service Call Tracking Module
  • Comprehensive Provider Management Option
  • Fully Integrated Healthcare Information Technology Services
  • Safe, Secure & Redundant Data Storage
  • Continually Upgraded Claims Processing and Admin Software

PROVIDER PORTAL SOLUTIONS

  • Appeals and Grievances
  • Document Management Solution
  • Compliance Portal
  • Regulatory Memo Tracking
  • SID Credentialing Portal
  • CTM Tracking Portal
  • DMS
  • HR Tracker
  • OEV
  • OTC
  • PR Activity System
  • PR Utility Portal
  • Provider Directory Portal

BUSINESS PROCESS OUTSOURCING (BPO) SOLUTIONS

Our expertise in various sectors throughout the healthcare landscape will allow you to focus on your core competencies, while we effectively manage your business processes. Our systems are continuously updated and improved to meet and exceed best practices, in order to allow you to avoid distractions from your primary areas of business.

Solutions Include:

  • Appeals & Grievances
  • Claims Administration
  • Credentialing
  • Enrollment
  • Fulfillment
  • IS Reporting
  • Medical & Quality Management
  • Member Communications
  • Member Services
  • Member Maintenance
  • MRA
  • OTC
  • Premium Billing
  • Provider Maintenance
  • Provider Services
  • Provider Communication
  • Revenue Management
  • Risk Management
  • System Configuration
  • Training
  • Utilization Management

PROVIDER MANAGEMENT SERVICES

Proprietary Technology for Provider Managers

A combination of proprietary technologies and services that deliver clean provider data, maintenance and transmission.

Key Benefits:

  • Clean corrupt provider databases
  • Manage all transmission to and from provider database
  • Maintain provider database files and integrity
  • Increase auto-adjudication rates

Features:

  • Unique Provider Data Scrub Technology
  • Provider Transmission Edits
  • Proprietary Matching Technology
  • Extensive Provider Database
  • Provider Validation Process
  • Reports Provider Detail
  • Duplicate Record Identification to Source

POST ADJUDICATION SERVICES

Services that simplify reporting and data analysis, as well as fulfillment and payment.

Key Benefits

  • Lower costs
  • Improve efficiency
  • Decrease distribution time
  • In-depth data analysis

Features

  • Electronic Funds Transfer (EFT)– Leading edge methodology and technology, providing rapid paperless payment to providers and members.
  • Fulfillment and Payment– Through global pricing and economies of scale, output fulfillment documents and payments can be distributed more efficiently.
  • Reporting and Data Analysis– Via a direct interface to customer data, we deliver a set of powerful analytical tools and reports, enabling users to dissect and machinate data to provide critical cost management information.

PRACTICE MANAGEMENT SOLUTIONS

Because different entities have different needs, our Practice Management Systems offer a full suite of features to serve independent providers, clinics, and physician groups. In addition to the lists provided below, our sales force will ensure that your specific needs are addressed.

  • Total document management (including scanning/faxing)
  • Comprehensive Practice Management features
  • Internal Communications Module
  • Rapid Patient Encounter Documentation
  • Integrated Lab Results with Alerts
  • All Electronic Ordering
  • Accepts Instant Online Payments
  • Integrated Patient Appointment Reminders
  • Quick Click Complete Chart Faxing
  • Vital Signs / Growth Charts
  • Interfaces with Vital Sign Measuring Devices
  • Automated Encounter Coding
  • Voice Recognition Compatibility
  • Real Time Eligibility Checking
  • PQRI reporting for additional Medicare reimbursement
  • Allows for diagnosis coding correlated to the HCC (Hierarchical Condition Categories) model

ELECTRONIC HEALTH RECORDS – E.H.R.

Features

Because different entities have different needs, our Electronic Health Records and Practice Management Systems offer a full suite of features to serve independent providers, clinics, and physician groups. In addition to the lists provided below, our sales force will ensure that your specific needs are addressed.

  • Total document management (including scanning/faxing)
  • Comprehensive Practice Management features
  • Internal Communications Module
  • Rapid Patient Encounter Documentation
  • Integrated Lab Results with Alerts
  • All Electronic Ordering
  • Accepts Instant Online Payments
  • Integrated Patient Appointment Reminders
  • Quick Click Complete Chart Faxing
  • Vital Signs / Growth Charts
  • Interfaces with Vital Sign Measuring Devices
  • Automated Encounter Coding
  • Voice Recognition Compatibility
  • Real Time Eligibility Checking
  • PQRI reporting for additional Medicare reimbursement
  • Allows for diagnosis coding correlated to the HCC (Hierarchical Condition Categories) model
  • Ideal for Independent Providers, FQHCs, and ACOs

CORE BENEFIT ADMINISTRATIVE SOLUTIONS

Efficient Technology with Low Ongoing Costs

A mature complement of SaaS based healthcare benefits software solutions for benefits administration and healthcare claims processing including benefits enrollment, member management, billing, claims workflow, auto-adjudication, and consumer-driven health plans allowing access to technology with low ongoing costs and efficient benefit plan administration. Our systems are fully capable of administering all types of health plans including commercial insurance, Medicare, Medicaid, self-funded (TPA or first party payer) plans, IPA’s, and ACO’s. Our systems are also fully integrated with our Front-End systems capability and our web portals allowing for the complete integration of member management and claims processing from claims receipt to claims payment.

Key Benefits

  • Drives high auto-adjudication rates
  • Flexible rules-based and programmable benefit plan administration
  • Manages consumer driven health plans (CDHP)
  • Complex data integration to vendors and HR systems
  • Flexibility for complex benefits plan design

Features

  • Complex Benefit Plan Configuration and Reimbursement Methodologies
  • High Auto-Adjudication for Claims Processing
  • Consumer-Driven Health Plans (CDHP/HRA/HSA)
  • Powerful Online, Real-Time Claims Workflow Engine
  • Integrated Medical Claims Editing and Code Bundling
  • Extensive Provider Database Management Administration
  • Data Integration to Vendors and HR Systems
  • Customer Service Call Tracking Module
  • Comprehensive Provider Management Option
  • Fully Integrated Healthcare Information Technology Services
  • Safe, Secure & Redundant Data Storage
  • Continually Upgraded Claims Processing and Admin Software

PROVIDER PORTAL SOLUTIONS

  • Appeals and Grievances
  • Document Management Solution
  • Compliance Portal
  • Regulatory Memo Tracking
  • SID Credentialing Portal
  • CTM Tracking Portal
  • DMS
  • HR Tracker
  • OEV
  • OTC
  • PR Activity System
  • PR Utility Portal
  • Provider Directory Portal

BUSINESS PROCESS OUTSOURCING (BPO) SOLUTIONS

Our expertise in various sectors throughout the healthcare landscape will allow you to focus on your core competencies, while we effectively manage your business processes. Our systems are continuously updated and improved to meet and exceed best practices, in order to allow you to avoid distractions from your primary areas of business.

Solutions Include:

  • Appeals & Grievances
  • Claims Administration
  • Credentialing
  • Enrollment
  • Fulfillment
  • IS Reporting
  • Medical & Quality Management
  • Member Communications
  • Member Services
  • Member Maintenance
  • MRA
  • OTC
  • Premium Billing
  • Provider Maintenance
  • Provider Services
  • Provider Communication
  • Revenue Management
  • Risk Management
  • System Configuration
  • Training
  • Utilization Management

PROVIDER MANAGEMENT SERVICES

Proprietary Technology for Provider Managers

A combination of proprietary technologies and services that deliver clean provider data, maintenance and transmission.

Key Benefits:

  • Clean corrupt provider databases
  • Manage all transmission to and from provider database
  • Maintain provider database files and integrity
  • Increase auto-adjudication rates

Features:

  • Unique Provider Data Scrub Technology
  • Provider Transmission Edits
  • Proprietary Matching Technology
  • Extensive Provider Database
  • Provider Validation Process
  • Reports Provider Detail
  • Duplicate Record Identification to Source

POST ADJUDICATION SERVICES

Services that simplify reporting and data analysis, as well as fulfillment and payment.

Key Benefits

  • Lower costs
  • Improve efficiency
  • Decrease distribution time
  • In-depth data analysis

Features

  • Electronic Funds Transfer (EFT)– Leading edge methodology and technology, providing rapid paperless payment to providers and members.
  • Fulfillment and Payment– Through global pricing and economies of scale, output fulfillment documents and payments can be distributed more efficiently.
  • Reporting and Data Analysis– Via a direct interface to customer data, we deliver a set of powerful analytical tools and reports, enabling users to dissect and machinate data to provide critical cost management information.

PRACTICE MANAGEMENT SOLUTIONS

Because different entities have different needs, our Practice Management Systems offer a full suite of features to serve independent providers, clinics, and physician groups. In addition to the lists provided below, our sales force will ensure that your specific needs are addressed.

  • Total document management (including scanning/faxing)
  • Comprehensive Practice Management features
  • Internal Communications Module
  • Rapid Patient Encounter Documentation
  • Integrated Lab Results with Alerts
  • All Electronic Ordering
  • Accepts Instant Online Payments
  • Integrated Patient Appointment Reminders
  • Quick Click Complete Chart Faxing
  • Vital Signs / Growth Charts
  • Interfaces with Vital Sign Measuring Devices
  • Automated Encounter Coding
  • Voice Recognition Compatibility
  • Real Time Eligibility Checking
  • PQRI reporting for additional Medicare reimbursement
  • Allows for diagnosis coding correlated to the HCC (Hierarchical Condition Categories) model

ELECTRONIC HEALTH RECORDS – E.H.R.

Features

Because different entities have different needs, our Electronic Health Records and Practice Management Systems offer a full suite of features to serve independent providers, clinics, and physician groups. In addition to the lists provided below, our sales force will ensure that your specific needs are addressed.

  • Total document management (including scanning/faxing)
  • Comprehensive Practice Management features
  • Internal Communications Module
  • Rapid Patient Encounter Documentation
  • Integrated Lab Results with Alerts
  • All Electronic Ordering
  • Accepts Instant Online Payments
  • Integrated Patient Appointment Reminders
  • Quick Click Complete Chart Faxing
  • Vital Signs / Growth Charts
  • Interfaces with Vital Sign Measuring Devices
  • Automated Encounter Coding
  • Voice Recognition Compatibility
  • Real Time Eligibility Checking
  • PQRI reporting for additional Medicare reimbursement
  • Allows for diagnosis coding correlated to the HCC (Hierarchical Condition Categories) model

CORE BENEFIT ADMINISTRATIVE SOLUTIONS

Efficient Technology with Low Ongoing Costs

A mature complement of SaaS based healthcare benefits software solutions for benefits administration and healthcare claims processing including benefits enrollment, member management, billing, claims workflow, auto-adjudication, and consumer-driven health plans allowing access to technology with low ongoing costs and efficient benefit plan administration. Our systems are fully capable of administering all types of health plans including commercial insurance, Medicare, Medicaid, self-funded (TPA or first party payer) plans, IPA’s, and ACO’s. Our systems are also fully integrated with our Front-End systems capability and our web portals allowing for the complete integration of member management and claims processing from claims receipt to claims payment.

Key Benefits

  • Drives high auto-adjudication rates
  • Flexible rules-based and programmable benefit plan administration
  • Manages consumer driven health plans (CDHP)
  • Complex data integration to vendors and HR systems
  • Flexibility for complex benefits plan design

Features

  • Complex Benefit Plan Configuration and Reimbursement Methodologies
  • High Auto-Adjudication for Claims Processing
  • Consumer-Driven Health Plans (CDHP/HRA/HSA)
  • Powerful Online, Real-Time Claims Workflow Engine
  • Integrated Medical Claims Editing and Code Bundling
  • Extensive Provider Database Management Administration
  • Data Integration to Vendors and HR Systems
  • Customer Service Call Tracking Module
  • Comprehensive Provider Management Option
  • Fully Integrated Healthcare Information Technology Services
  • Safe, Secure & Redundant Data Storage
  • Continually Upgraded Claims Processing and Admin Software

PROVIDER PORTAL SOLUTIONS

  • Appeals and Grievances
  • Document Management Solution
  • Compliance Portal
  • Regulatory Memo Tracking
  • SID Credentialing Portal
  • CTM Tracking Portal
  • DMS
  • HR Tracker
  • OEV
  • OTC
  • PR Activity System
  • PR Utility Portal
  • Provider Directory Portal

BUSINESS PROCESS OUTSOURCING (BPO) SOLUTIONS

Our expertise in various sectors throughout the healthcare landscape will allow you to focus on your core competencies, while we effectively manage your business processes. Our systems are continuously updated and improved to meet and exceed best practices, in order to allow you to avoid distractions from your primary areas of business.

Solutions Include:

  • Appeals & Grievances
  • Claims Administration
  • Credentialing
  • Enrollment
  • Fulfillment
  • IS Reporting
  • Medical & Quality Management
  • Member Communications
  • Member Services
  • Member Maintenance
  • MRA
  • OTC
  • Premium Billing
  • Provider Maintenance
  • Provider Services
  • Provider Communication
  • Revenue Management
  • Risk Management
  • System Configuration
  • Training
  • Utilization Management

PROVIDER MANAGEMENT SERVICES

Proprietary Technology for Provider Managers

A combination of proprietary technologies and services that deliver clean provider data, maintenance and transmission.

Key Benefits:

  • Clean corrupt provider databases
  • Manage all transmission to and from provider database
  • Maintain provider database files and integrity
  • Increase auto-adjudication rates

Features:

  • Unique Provider Data Scrub Technology
  • Provider Transmission Edits
  • Proprietary Matching Technology
  • Extensive Provider Database
  • Provider Validation Process
  • Reports Provider Detail
  • Duplicate Record Identification to Source

POST ADJUDICATION SERVICES

Services that simplify reporting and data analysis, as well as fulfillment and payment.

Key Benefits

  • Lower costs
  • Improve efficiency
  • Decrease distribution time
  • In-depth data analysis

Features

  • Electronic Funds Transfer (EFT)– Leading edge methodology and technology, providing rapid paperless payment to providers and members.
  • Fulfillment and Payment– Through global pricing and economies of scale, output fulfillment documents and payments can be distributed more efficiently.
  • Reporting and Data Analysis– Via a direct interface to customer data, we deliver a set of powerful analytical tools and reports, enabling users to dissect and machinate data to provide critical cost management information.

PRACTICE MANAGEMENT SOLUTIONS

Because different entities have different needs, our Practice Management Systems offer a full suite of features to serve independent providers, clinics, and physician groups. In addition to the lists provided below, our sales force will ensure that your specific needs are addressed.

  • Total document management (including scanning/faxing)
  • Comprehensive Practice Management features
  • Internal Communications Module
  • Rapid Patient Encounter Documentation
  • Integrated Lab Results with Alerts
  • All Electronic Ordering
  • Accepts Instant Online Payments
  • Integrated Patient Appointment Reminders
  • Quick Click Complete Chart Faxing
  • Vital Signs / Growth Charts
  • Interfaces with Vital Sign Measuring Devices
  • Automated Encounter Coding
  • Voice Recognition Compatibility
  • Real Time Eligibility Checking
  • PQRI reporting for additional Medicare reimbursement
  • Allows for diagnosis coding correlated to the HCC (Hierarchical Condition Categories) model

ELECTRONIC HEALTH RECORDS – E.H.R.

Features

Because different entities have different needs, our Electronic Health Records and Practice Management Systems offer a full suite of features to serve independent providers, clinics, and physician groups. In addition to the lists provided below, our sales force will ensure that your specific needs are addressed.

  • Total document management (including scanning/faxing)
  • Comprehensive Practice Management features
  • Internal Communications Module
  • Rapid Patient Encounter Documentation
  • Integrated Lab Results with Alerts
  • All Electronic Ordering
  • Accepts Instant Online Payments
  • Integrated Patient Appointment Reminders
  • Quick Click Complete Chart Faxing
  • Vital Signs / Growth Charts
  • Interfaces with Vital Sign Measuring Devices
  • Automated Encounter Coding
  • Voice Recognition Compatibility
  • Real Time Eligibility Checking
  • PQRI reporting for additional Medicare reimbursement
  • Allows for diagnosis coding correlated to the HCC (Hierarchical Condition Categories) model
  • Ideal for Independent Providers, FQHCs, and ACOs

SOLUTIONS FOR SPECIAL NEEDS

Our EHR Coordinated Care Solution is designed to serve clinics focused on indigent patient needs, creating a seamless flow of patient information for all your clinics. State mandated payment requirements, such as sliding-scale pricing and Medicaid reporting, are built into the system with FQHCs in mind. Financial reporting per clinic, provider, or in-aggregate, is easily obtainable. Management and clinicians will have peace-of-mind knowing that charts will no longer be lost when patients transition from one in-house provider to another.

CORE BENEFIT ADMINISTRATIVE SOLUTIONS

Efficient Technology with Low Ongoing Costs

A mature complement of SaaS based healthcare benefits software solutions for benefits administration and healthcare claims processing including benefits enrollment, member management, billing, claims workflow, auto-adjudication, and consumer-driven health plans allowing access to technology with low ongoing costs and efficient benefit plan administration. Our systems are fully capable of administering all types of health plans including commercial insurance, Medicare, Medicaid, self-funded (TPA or first party payer) plans, IPA’s, and ACO’s. Our systems are also fully integrated with our Front-End systems capability and our web portals allowing for the complete integration of member management and claims processing from claims receipt to claims payment.

Key Benefits

  • Drives high auto-adjudication rates
  • Flexible rules-based and programmable benefit plan administration
  • Manages consumer driven health plans (CDHP)
  • Complex data integration to vendors and HR systems
  • Flexibility for complex benefits plan design

Features

  • Complex Benefit Plan Configuration and Reimbursement Methodologies
  • High Auto-Adjudication for Claims Processing
  • Consumer-Driven Health Plans (CDHP/HRA/HSA)
  • Powerful Online, Real-Time Claims Workflow Engine
  • Integrated Medical Claims Editing and Code Bundling
  • Extensive Provider Database Management Administration
  • Data Integration to Vendors and HR Systems
  • Customer Service Call Tracking Module
  • Comprehensive Provider Management Option
  • Fully Integrated Healthcare Information Technology Services
  • Safe, Secure & Redundant Data Storage
  • Continually Upgraded Claims Processing and Admin Software

PROVIDER PORTAL SOLUTIONS

  • Appeals and Grievances
  • Document Management Solution
  • Compliance Portal
  • Regulatory Memo Tracking
  • SID Credentialing Portal
  • CTM Tracking Portal
  • DMS
  • HR Tracker
  • OEV
  • OTC
  • PR Activity System
  • PR Utility Portal
  • Provider Directory Portal

BUSINESS PROCESS OUTSOURCING (BPO) SOLUTIONS

Our expertise in various sectors throughout the healthcare landscape will allow you to focus on your core competencies, while we effectively manage your business processes. Our systems are continuously updated and improved to meet and exceed best practices, in order to allow you to avoid distractions from your primary areas of business.

Solutions Include:

  • Appeals & Grievances
  • Claims Administration
  • Credentialing
  • Enrollment
  • Fulfillment
  • IS Reporting
  • Medical & Quality Management
  • Member Communications
  • Member Services
  • Member Maintenance
  • MRA
  • OTC
  • Premium Billing
  • Provider Maintenance
  • Provider Services
  • Provider Communication
  • Revenue Management
  • Risk Management
  • System Configuration
  • Training
  • Utilization Management

SMART FRONT-END SERVICES

A Unique Package

Healthaxis’ Smart Front EndSM is a unique package of products and services, including advanced mailroom services, healthcare claims OCR and data capture, claims repricing, and healthcare claims workflow which markedly enhances auto-adjudication rates. All our healthcare IT solutions are customized based on customer need. Our mailroom, scanning and OCR services can be utilized individually, in combination, or in total.

Key Benefits

  • Higher productivity and lower administrative costs
  • Real-time claims workflow and status monitoring
  • Controls document workflow and activity

Features

  • Document Receipt– Provides functionality for complete customized mailroom services, imaging and EDI.
  • Document Control– Provides a real time workflow monitor to all document processing which includes customer-defined triggers to maintain client-defined objectives.
  • Data Conversion– Delivers OCR and manual conversion through proprietary systems that can be custom configured based on client specifications.
  • Data Validation– Addresses coverage eligibility, postal standardization, SIC and client-defined data fields.
  • Claims Matching– Provides a robust matching platform for network routing and claims pricing.
  • Claims Edits– Utilizes complex medical rules-based technology increasing auto-adjudication rates and benefit savings as well as improving workflow efficiency.
  • Claims Routing– Provides a flexible platform for transmitting claims to networks and other client-defined destinations.
  • Claims Pricing– Offers a configurable Healthaxis claim-pricing engine that reduces cost and turnaround time.

*For optimum performance combine Smart Front EndSM with Provider Management.


PROVIDER MANAGEMENT SERVICES

Proprietary Technology for Provider Managers

A combination of proprietary technologies and services that deliver clean provider data, maintenance and transmission.

Key Benefits:

  • Clean corrupt provider databases
  • Manage all transmission to and from provider database
  • Maintain provider database files and integrity
  • Increase auto-adjudication rates

Features:

  • Unique Provider Data Scrub Technology
  • Provider Transmission Edits
  • Proprietary Matching Technology
  • Extensive Provider Database
  • Provider Validation Process
  • Reports Provider Detail
  • Duplicate Record Identification to Source

POST ADJUDICATION SERVICES

Services that simplify reporting and data analysis, as well as fulfillment and payment.

Key Benefits

  • Lower costs
  • Improve efficiency
  • Decrease distribution time
  • In-depth data analysis

Features

  • Electronic Funds Transfer (EFT)– Leading edge methodology and technology, providing rapid paperless payment to providers and members.
  • Fulfillment and Payment– Through global pricing and economies of scale, output fulfillment documents and payments can be distributed more efficiently.
  • Reporting and Data Analysis– Via a direct interface to customer data, we deliver a set of powerful analytical tools and reports, enabling users to dissect and machinate data to provide critical cost management information.

PRACTICE MANAGEMENT SOLUTIONS

Because different entities have different needs, our Practice Management Systems offer a full suite of features to serve independent providers, clinics, and physician groups. In addition to the lists provided below, our sales force will ensure that your specific needs are addressed.

  • Total document management (including scanning/faxing)
  • Comprehensive Practice Management features
  • Internal Communications Module
  • Rapid Patient Encounter Documentation
  • Integrated Lab Results with Alerts
  • All Electronic Ordering
  • Accepts Instant Online Payments
  • Integrated Patient Appointment Reminders
  • Quick Click Complete Chart Faxing
  • Vital Signs / Growth Charts
  • Interfaces with Vital Sign Measuring Devices
  • Automated Encounter Coding
  • Voice Recognition Compatibility
  • Real Time Eligibility Checking
  • PQRI reporting for additional Medicare reimbursement
  • Allows for diagnosis coding correlated to the HCC (Hierarchical Condition Categories) model

ELECTRONIC HEALTH RECORDS – E.H.R.

Features

Because different entities have different needs, our Electronic Health Records and Practice Management Systems offer a full suite of features to serve independent providers, clinics, and physician groups. In addition to the lists provided below, our sales force will ensure that your specific needs are addressed.

  • Total document management (including scanning/faxing)
  • Comprehensive Practice Management features
  • Internal Communications Module
  • Rapid Patient Encounter Documentation
  • Integrated Lab Results with Alerts
  • All Electronic Ordering
  • Accepts Instant Online Payments
  • Integrated Patient Appointment Reminders
  • Quick Click Complete Chart Faxing
  • Vital Signs / Growth Charts
  • Interfaces with Vital Sign Measuring Devices
  • Automated Encounter Coding
  • Voice Recognition Compatibility
  • Real Time Eligibility Checking
  • PQRI reporting for additional Medicare reimbursement
  • Allows for diagnosis coding correlated to the HCC (Hierarchical Condition Categories) model
  • Ideal for Independent Providers, FQHCs, and ACOs

SOLUTIONS FOR SPECIAL NEEDS

The proper and effective flow of information among providers is central to the mission of any ACO. Information should reach the appropriate party at the right time in order to make patient care as efficient as possible. Our solutions are geared to help all of the parties involved in a patient’s care efficiently coordinate their services as much as possible.  

CORE BENEFIT ADMINISTRATIVE SOLUTIONS

Efficient Technology with Low Ongoing Costs

A mature complement of SaaS based healthcare benefits software solutions for benefits administration and healthcare claims processing including benefits enrollment, member management, billing, claims workflow, auto-adjudication, and consumer-driven health plans allowing access to technology with low ongoing costs and efficient benefit plan administration. Our systems are fully capable of administering all types of health plans including commercial insurance, Medicare, Medicaid, self-funded (TPA or first party payer) plans, IPA’s, and ACO’s. Our systems are also fully integrated with our Front-End systems capability and our web portals allowing for the complete integration of member management and claims processing from claims receipt to claims payment.

Key Benefits

  • Drives high auto-adjudication rates
  • Flexible rules-based and programmable benefit plan administration
  • Manages consumer driven health plans (CDHP)
  • Complex data integration to vendors and HR systems
  • Flexibility for complex benefits plan design

Features

  • Complex Benefit Plan Configuration and Reimbursement Methodologies
  • High Auto-Adjudication for Claims Processing
  • Consumer-Driven Health Plans (CDHP/HRA/HSA)
  • Powerful Online, Real-Time Claims Workflow Engine
  • Integrated Medical Claims Editing and Code Bundling
  • Extensive Provider Database Management Administration
  • Data Integration to Vendors and HR Systems
  • Customer Service Call Tracking Module
  • Comprehensive Provider Management Option
  • Fully Integrated Healthcare Information Technology Services
  • Safe, Secure & Redundant Data Storage
  • Continually Upgraded Claims Processing and Admin Software

PROVIDER PORTAL SOLUTIONS

  • Appeals and Grievances
  • Document Management Solution
  • Compliance Portal
  • Regulatory Memo Tracking
  • SID Credentialing Portal
  • CTM Tracking Portal
  • DMS
  • OEV
  • OTC
  • PR Activity System
  • PR Utility Portal
  • Provider Directory Portal

BUSINESS PROCESS OUTSOURCING (BPO) SOLUTIONS

Our expertise in various sectors throughout the healthcare landscape will allow you to focus on your core competencies, while we effectively manage your business processes. Our systems are continuously updated and improved to meet and exceed best practices, in order to allow you to avoid distractions from your primary areas of business.

Solutions Include:

  • Appeals & Grievances
  • Claims Administration
  • Credentialing
  • Enrollment
  • Fulfillment
  • IS Reporting
  • Medical & Quality Management
  • Member Communications
  • Member Services
  • Member Maintenance
  • MRA
  • OTC
  • Premium Billing
  • Provider Maintenance
  • Provider Services
  • Provider Communication
  • Revenue Management
  • Risk Management
  • System Configuration
  • Training
  • Utilization Management

PROVIDER MANAGEMENT SERVICES

Proprietary Technology for Provider Managers

A combination of proprietary technologies and services that deliver clean provider data, maintenance and transmission.

Key Benefits

  • Clean corrupt provider databases
  • Manage all transmission to and from provider database
  • Maintain provider database files and integrity
  • Increase auto-adjudication rates

Features

  • Unique Provider Data Scrub Technology
  • Provider Transmission Edits
  • Proprietary Matching Technology
  • Extensive Provider Database
  • Provider Validation Process
  • Reports Provider Detail
  • Duplicate Record Identification to Source

PRACTICE MANAGEMENT SOLUTIONS

Because different entities have different needs, our Practice Management Systems offer a full suite of features to serve independent providers, clinics, and physician groups. In addition to the lists provided below, our sales force will ensure that your specific needs are addressed.

  • Total document management (including scanning/faxing)
  • Comprehensive Practice Management features
  • Internal Communications Module
  • Rapid Patient Encounter Documentation
  • Integrated Lab Results with Alerts
  • All Electronic Ordering
  • Accepts Instant Online Payments
  • Integrated Patient Appointment Reminders
  • Quick Click Complete Chart Faxing
  • Vital Signs / Growth Charts
  • Interfaces with Vital Sign Measuring Devices
  • Automated Encounter Coding
  • Voice Recognition Compatibility
  • Real Time Eligibility Checking
  • PQRI reporting for additional Medicare reimbursement
  • Allows for diagnosis coding correlated to the HCC (Hierarchical Condition Categories) model

ELECTRONIC HEALTH RECORDS – E.H.R.

Features

Because different entities have different needs, our Electronic Health Records and Practice Management Systems offer a full suite of features to serve independent providers, clinics, and physician groups. In addition to the lists provided below, our sales force will ensure that your specific needs are addressed.

  • Total document management (including scanning/faxing)
  • Comprehensive Practice Management features
  • Internal Communications Module
  • Rapid Patient Encounter Documentation
  • Integrated Lab Results with Alerts
  • All Electronic Ordering
  • Accepts Instant Online Payments
  • Integrated Patient Appointment Reminders
  • Quick Click Complete Chart Faxing
  • Vital Signs / Growth Charts
  • Interfaces with Vital Sign Measuring Devices
  • Automated Encounter Coding
  • Voice Recognition Compatibility
  • Real Time Eligibility Checking
  • PQRI reporting for additional Medicare reimbursement
  • Allows for diagnosis coding correlated to the HCC (Hierarchical Condition Categories) model
  • Ideal for Independent Providers, FQHCs, and ACOs