Adjudicator

Adjudicator

Cervey
Complete Claims

Complete Claims

Complete Health Systems
Adjudicator Complete Claims

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Adjudicator:

About

Adjudicator is a plan management and prescription claims adjudication platform for pharmacy benefit managers, health plans, hospitals and health systems, pharmacy programs, managed care organizations, manufacturers, and retail pharmacies. It supports configurable plan designs and benefit structures, multi-tenant environments, pharmacy network configurations, and management of drugs, formularies, and maximum allowable cost (MAC) pricing. Its member portal provides real-time benefit-status and pending-claim tracking, secure document uploads, and notifications. A prior authorization dashboard provides access to claims data and secure communications. An API framework supports data exchange with internal processes and external business partners. Adjudicator helps organizations manage pharmacy benefits and prescription claims.
Complete Claims:

About

Claims Adjudication for medical, dental, vision, prescription, short and long-term disability claims. Available for on-site license or as a hosted application (ASP). Microsoft technology: SQLServer database with a Windows front end. Acclaimed Customer service staffed by health care claims experts with a minimum of 12 years’ experience in the field. Support calls are logged with status available via the internet. Plan copy and modification feature enable quick setup of plans. Auto-adjudication using benefit codes built using business rules based on over 25 variables from both the claim and the claimant records made available to the adjudication engine. Inbound claims can be scanned images, EDI or paper. HIPAA EDI 5010 transaction sets. Re-pricing fee and UCR Schedules can be loaded on the system in advance of the effective date. The date-driven logic will re-price based on the date of service.
Adjudicator:

Platforms Supported

Windows Not Supported
Mac Not Supported
Linux Not Supported
Cloud Supported
On-Premises Not Supported
iPhone Not Supported
iPad Not Supported
Android Not Supported
Chromebook Not Supported
Complete Claims:

Platforms Supported

Windows Not Supported
Mac Not Supported
Linux Not Supported
Cloud Supported
On-Premises Not Supported
iPhone Not Supported
iPad Not Supported
Android Not Supported
Chromebook Not Supported
Adjudicator:

Audience

Prescription Benefit Managers (PBMs), Third-Party Administrators (TPAs), Self-Funded Employers, Health Plans, Hospitals & Health Systems, Pharmaceutical Manufacturers, Cash & Discount Card Sponsors, Retail Chain Pharmacies
Complete Claims:

Audience

Businesses in need of a tool to manage their claims adjudication processes
Adjudicator:

Support

Phone Support Supported
24/7 Live Support Supported
Online Not Supported
Complete Claims:

Support

Phone Support Supported
24/7 Live Support Not Supported
Online Supported
Adjudicator:

API

Offers API Supported
Complete Claims:

API

Offers API Not Supported
Adjudicator:

Screenshots and Videos

Complete Claims:

Screenshots and Videos

Adjudicator:

Pricing

No information available.
Free Version Not Supported
Free Trial Not Supported
Complete Claims:

Pricing

No information available.
Free Version Not Supported
Free Trial Not Supported
Adjudicator:

Reviews/Ratings

Overall 0.0 / 5
ease 0.0 / 5
features 0.0 / 5
design 0.0 / 5
support 0.0 / 5

This software hasn't been reviewed yet. Be the first to provide a review:

Review this Software
Complete Claims:

Reviews/Ratings

Overall 0.0 / 5
ease 0.0 / 5
features 0.0 / 5
design 0.0 / 5
support 0.0 / 5

This software hasn't been reviewed yet. Be the first to provide a review:

Review this Software
Adjudicator:

Training

Documentation Supported
Webinars Supported
Live Online Supported
In Person Supported
Complete Claims:

Training

Documentation Not Supported
Webinars Not Supported
Live Online Not Supported
In Person Not Supported
Adjudicator:

Company Information

Cervey
Founded: 1978
United States
cervey.com
Complete Claims:

Company Information

Complete Health Systems
completehealthsys.com/claims/
Adjudicator:

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Adjudicator:

Categories

Complete Claims:

Categories

Claims Processing Supported
Health Insurance Supported
Adjudicator:

Integrations

No info available.
Complete Claims:

Integrations

No info available.
Adjudicator:
Claim Adjudicator and update features and information
Claim Adjudicator and update features and information
Complete Claims:
Claim Complete Claims and update features and information
Claim Complete Claims and update features and information