This is a one-stop solution for all-payer requirements. It has configurable workflows that enable the users to easily manage end-to-end workflows, starting from enrollment to claims payment, collecting & viewing member benefits, and claiming history on their fingertips using a mobile app and web portal. It connects all the parties on one unified platform, which makes claim processing faster & easier. It also offers a seamless view of claim status to members, providers & payers. Additionally, the complete suite provides independent modules like credentialing, Grievances and Appeal (G & A), Utilization Management (UM) & Business Intelligence tools that seamlessly integrate with other legacy applications.
Key Features
Built-in contracts management and rule engine for a faster claim’s adjudication process
Collaborative portal to bring stakeholders for communication and tracking of claims
EDI integration (e.g., 835, 837) for electronic transfer of data according to regulatory guidelines
Workflows to manage the entire lifecycle of claims origination to payments
Notifications for updates and pending actions for claims
Advanced analytics and reporting for claims history, payment history