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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Efficient claims adjudication is vital in the competitive healthcare industry, where accuracy and minimal re-work are essential. Payers need an optimized claims operation system with accurate data and interconnected systems for flexibility and growth.
Introducing Claims360, our fully integrated claims adjudication solution designed for complex value-based health products like HMO, PPO, and POS. With a powerful rules-based engine, Claims360 automates all workflows for accurate and efficient claims
processing. From benefits administration to membership and provider data management, coordination of benefits, and codified contract management, Claims360 offers a comprehensive solution tailored to your organization's needs.
Rules-based engine to automate all claims adjudication workflows, including:
Auto-adjudication, Benefit administration, Membership data management and integration
Codified contract management, and more
Eligibilities and more.
Provider data management and integration
Coordination of benefits
Flexible payment scheduling options, including:
Flexible API integration offering ... that has pre-configured pend rules/logics that can be customized to meet payer specifications. Claims meeting these standards qualify for manual adjudication, and an automated process reprocesses the claim based on a timed schedule. For example, a rule can:
Read moreReal-time payment
Daily, weekly, or custom payment schedules
With Claims360, you gain the flexibility to pay claims in real-time or schedule payments daily, weekly, or on a customized basis. The solution offers seamless API integration, allowing easy connectivity with other systems. It also provides preconfigured pend rules/logic that can be customized to meet specific payer requirements, ensuring accurate and compliant claims processing.
Claims360's adaptable, rules-based core claims administration solution is designed to deliver increased payment and financial accuracy, helping you stay ahead of the competition and meet the demands of the rapidly changing healthcare industry.
Contact us today to unlock the power of seamless claims management and empower your organization with efficient and accurate claims processing with Claims360.
