HealthAxis Group offers a Comprehensive Suite of Products and Services

For all types of Healthcare Payer and Provider Organizations

To improve your most important Operational Situations

Payer Solutions

OverviewCore Benefit Administrative SolutionsSmart Front-End ServicesWeb-Based SolutionsPost Adjudication ServicesProvider Management ServicesPortal Solutions

HealthAxis offers a wide array of products and services, including Payer Solutions, that, combined with our experience and technical knowledge, enables payers to drive down costs, improve operational efficiencies and deliver value to their customers. Our aim is to stage a relentless attack on inefficiency, errors, and escalating administrative/medical costs while helping our customers compete more effectively.

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 healthplans 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

 

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.

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

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.

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

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

Coordinated Care

OverviewUnified SolutionEligibility & EnrollmentProvider Network ManagementHealth ServicesClaims Administration Reporting EHR - Coordinated CarePortal Solutions

The HealthAxis Coordinated Care Solution is a web delivered solution incorporating full functionality for all business requirements of any managed care organization, ACO, or MSO/TPA. The solution is delivered on a per member per month basis and is highly scalable. The solution is customer driven and is guaranteed to comply with the latest regulatory or compliance standards from CMS and any Federal, State or Industry organization.

ONE PLATFORM, MULTIPLE MODELS

  • Cloud Based SaaS offering
  • Supports Numerous Care Delivery Network Arrangements including IPA, ACO, Regional Government and Self-Insured Arrangements
  • Scalable to millions of lives and thousands of users, supports multi-administrative office models.
  • Turnkey EDI integration for eligibility and capitation data for all health plans
  • Manage and reconcile cap and elligibility
  • Provider and clearinghouse integration supports instant eligibility inquiries
  • Clinic, PCP and Facility Assignment
  • Complete Credentialing Module
  • Provider appeals and dispute resolution
  • Provide and Hospital Capitation
  • Provider Portals for Claims, authorizations and eligibility
  • Authorizations and Care Coordination
  • Acute and Complex Case Management
  • Care Planning and Disease Management
  • Integrated Inbound and Outbound eFax
  • HEDIS and EHR Interoperability Options
  • Supports high auto-adjudication rates
  • Comprehensive benefit plan, DOFR and fee schedule configuration options
  • Electronic EDI for Claims, Encounters, EOR, EOB and eligibility request and response; HIPAA 5010 ready
  • Integrated Document Management and BPO Services Available
  • HCC and P4P administration, tracking and reporting
  • Extensive library and report write
  • Industry standard letters, report cards and management reports.

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

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

Provider Solutions

OverviewElectronic Health Records (EHR)Costs and LimitationsSolutions for Special Needs

We offer billing, demographics, and an appointment scheduling system for physicians’ offices and ambulatory care clinics.

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 solutions provided here, our sales force will ensure that your specific needs are addressed.

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

HealthAxis is certified in the ONC Health IT Certification Program. We are committed to making the costs and performance of our EHR products and services visible and transparent to our clients.

Complete EHR Program HealthAxis’ powerful, user-friendly, certified EHR, delivers functionality and workflow that enhances practice performance. The Complete EHR program consists of fully integrated electronic health records, practice management, scheduling and billing functionality.

There is a one-time implementation cost and an ongoing monthly service maintenance cost for the Complete EHR. Costs are based upon the practice size.

*HealthAxis EHR may require one-time costs to establish interfaces for reporting to immunization registries and public health agencies.

Developer name – HealthAxis Group

Date the product was certified – 4/23/15

Product name – HealthAxis EHR

Product version – V2.0

Unique certification number – 04232015-1971-1

Certification criterion or criteria to which the product has been certified – 170.314 (a)(1-15); (b)(1-5, 7); (c)(1-3); (d)(1-8); (e)(1-3); (f)(1-3); (g)(2-4)

CQMs to which the product has been certified – 2v3; 50v2; 62v2; 69v2; 77v2; 126v2; 138v2; 147v2; 153v2; 158v2; 165v2

Any additional software the certified product relied upon to demonstrate its compliance with certification criteria – DrFirst Rcopia, Superscripts Network for Clinical Interoperability

ONC Disclaimer: “This Complete EHR is 2014 Edition compliant and has been certified by an ONC-ACB in accordance with the applicable certification criteria adopted by the Secretary of Health and Human Services. This certification does not represent an endorsement by the U.S. Department of Health and Human Services.”

INDEPENDENT PROVIDERS

Our EHR Provider Solutions system is geared to our private practice clients. Whether it be a single physician practice, or a large multi-specialty clinic, we have the features to make your practice as efficient as possible.

FQHC’s 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.

ACO’s 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.

Business Process Outsourcing

OverviewBPO SolutionsPerformance StandardsMember Services

HealthAxis Group offers Business Process Outsourcing Solutions through our internally managed systems, and through our strategic partnerships. 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

  • 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
  • Mailroom Services
  • OCR and Claims Data Capture Services
PERFORMANCE STANDARDS

Time Service Report 1st six months 2013 (Medicare):

CMS Regulatory Requirements

  • Within 30 days – 95%
  • Within 60 days – 100%

Beacon Client 1

  • Within 30 days – 97.29%
  • Within 60 days – 99.96%

Beacon Client 2

  • Within 30 days – 99.74%
  • Within 60 days – 99.96%

Claims Processing Audit

  • Financial Accuracy – 99%
  • Statistical Accuracy – 100%

Data Entry Audit

  • 02%

HEDIS / STARs

MEMBER SERVICES

What makes HealthAxis the best choice for Member Services?

  • Extreme experience in delivering outstanding service.
  • Fully customizable training – Developed by working closely with clients to meet their needs.
  • Comprehensive Call Center Reporting, ensuring transparency. The Call Center is meeting all CMS required metrics.

Our Member Service Performance Standards include:

  • Abandonment rate of less than 5%
  • Answer 80-90% of all calls in 30 seconds or less
  • Maintain an average wait time of less than 2 minutes.