Complete ClaimsComplete Health Systems
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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.
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About
Five Sigma set out on a mission to allow claims organizations to innovate. With the set of claims management tools and unique platform, Five Sigma's suite is what Insurers need to bring their claims operation to the rapidly changing world. With our suite of Claims-First Cloud-Native and User-Centric products, we enable adjusters to handle claims better and faster. With Automating administrative tasks, Adjusters can focus on making the right decisions, while the system takes care of everything else. Clive™ by Five Sigma is the industry's first AI-powered claims adjuster, transforming how claims are processed by insurers, MGAs, and TPAs. Leveraging advanced AI and automation, Clive streamlines the entire claims lifecycle, from FNOL (First Notice of Loss) through to settlement. The AI agent enhances claims handling efficiency, accuracy, and cost reduction by automating tasks.
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Platforms Supported
Windows
Mac
Linux
Cloud
On-Premises
iPhone
iPad
Android
Chromebook
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Platforms Supported
Windows
Mac
Linux
Cloud
On-Premises
iPhone
iPad
Android
Chromebook
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Audience
Businesses in need of a tool to manage their claims adjudication processes
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Audience
Companies looking for a SaaS claims platform that enables adjusters and management to enhance claims resolution
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Support
Phone Support
24/7 Live Support
Online
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Support
Phone Support
24/7 Live Support
Online
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API
Offers API
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API
Offers API
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Screenshots and Videos |
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Pricing
No information available.
Free Version
Free Trial
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Pricing
No information available.
Free Version
Free Trial
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Reviews/
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Reviews/
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Training
Documentation
Webinars
Live Online
In Person
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Training
Documentation
Webinars
Live Online
In Person
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Company InformationComplete Health Systems
completehealthsys.com/claims/
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Company InformationFive Sigma
United States
www.fivesigmalabs.com
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Categories |
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Integrations
No info available.
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Integrations
No info available.
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