Claims and Encounter Management system is built on Enterprise Transaction manager platform to generate, validate, send, receive and reconcile 837 I/P/D transactions. It is fast, highly configurable and scalable architecture enables processing more than half a million claims a day, increasing the auto-adjudication rates and reducing claim denials.
Eligibility Management system is built on Enterprise Transaction manager platform to streamline and automate the enrollment lifecycle. It’s highly scalable, API based architecture enables processing millions of enrollment records within a very short period thereby significantly enhancing Eligibility load and coverage turnaround time.
Enhance collaboration with numerous providers and vendors, and the shared services approach reduces redundancies and includes predictable pricing, allowing for higher volumes of transactions, including eligibility, and claim status.
Predictive analytics with real-time dashboard reporting and analytics, to enhance the ability to plan for future demand as eligible populations grow and shrink, easing budget restrictions.
Complete EDI solution to integrate any EDI and non-EDI transaction across Payers, providers and clearing houses. Implement 834, 837, 820, 835, 271, 270, 275 and 278 transactions. Pre integrated with leading claims systems like Qnxt, HealthEdge, Facets and others.
Workflow Automation to simplify workflows, decreases paperwork and reduces waste.
Connect provider and payer systems through their preferred channel (SFTP, web based Direct Data Entry, Secure Private network, mobile phones or tablets) making communication easier and the exchange of information more secured, timely and accurate.
Integration of Patient, Provider, Member & Health Plan data in near real-time bi-directional manner using Interoperability Hub – FHIR API Integration.Drive PHM campaigns through our platform engagement.Patient outreach / digital engagement using platform outreach for decreased MLR. Population Risk Assessment & Stratification, Care Coordination & Management and Effective Member Engagement.