Our Claims360 solution provides an efficient and automated solution for claims adjudication. This system integrates all claims-related data and processes for a 360-degree view of the claims and enables real-time processing and monitoring of claims.
CredsVault offers secure storage and management of sensitive provider credentialing information, making it easier to maintain compliance and minimize risks.
Our WiseLens solution provides advanced data analytics and reporting capabilities to help payers make informed decisions and improve overall operations.
Our Auth360 solution provides a comprehensive utilization management solution that helps payers make informed decisions, improve care quality, and reduce costs.
Our Auth360 prior authorization solution streamlines the prior authorization process, reduces administrative costs, and improves overall efficiency.
CallsDesk is a call center solution designed specifically for healthcare payers. This solution streamlines the call center process and enhances customer service while improving operational efficiency.
MemberDesk is a member portal that provides members with real-time access to their information and benefits and the ability to log disputes and grievances.
Our ProviderDesk solution provides a streamlined and efficient process for managing provider information and interactions, including prior authorization requests and dispute resolution.
Our AI Audit HUB solution leverages predictive analytics and machine learning to identify potential revenue leakage, reduce rework, and improve the payment accuracy of claims.
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As healthcare payers strive to improve their bottom line while providing high-quality services to their members, the Claims Administration is essential to achieving these goals. With the ever-increasing volume of claims, the pressure is on to ensure claims are processed accurately and efficiently. That's where Claims360 and AI Audit Hub come in.
Claims360 provides a comprehensive Claims Adjudication solution that covers the entire process from start to finish. The solution includes Benefit Management, Repricing, Claims Rework, Grievances and Appeals, and Claims Audit Review to ensure effective claims administration.
Claims360 provides a robust benefits management module that enables payers to configure and manage benefits in real time. This module provides a complete view of all the benefits available to members, making it easier for payers to manage their benefits and ensure members receive the care they need.
Claims360's repricing module help payers ensure that they are paying the correct amount for each claim. The solution uses advanced algorithms to determine the appropriate price for each claim, considering the member's benefit plan and other factors.
The Claims Rework module in Claims360 helps payers quickly identify and resolve claims that require additional review or adjustment. The solution uses advanced algorithms to identify claims that need rework and then provides a streamlined process for addressing the issues.
Claims360 provides a comprehensive Grievances and Appeals solution that enables payers to manage and resolve member complaints and appeals quickly and effectively. The solution offers a robust case management system, making it easier for payers to track the progress of each grievance or appeal and ensuring that members receive a timely resolution.
Claims Audit Review is a critical component of Claims Administration. Claims360's AI Audit Hub solution provides a predictive audit review and sampling approach and a stratified/sampling audit methodology to help payers identify and address potential issues with their claims processing. The solution uses advanced analytics to identify patterns and trends, making it easier for payers to make informed decisions about their claims administration processes.
Claims360 and AI Audit Hub provide a comprehensive solution for Claims Administration that enables payers to deliver efficient and accurate results. With their advanced features and cutting-edge technology, Claims360, and AI Audit Hub are the ideal solutions for healthcare payers looking to improve their bottom line while providing top-notch services to their members.
