Complete ClaimsComplete Health Systems
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InsightPro.aiMDI NetworX
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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
InsightPro is a web-based workforce analytics and operations platform for health insurance payers, third-party administrators, benefit administrators, and health plans. It supports claims operations, quality assurance, and member contact-center teams. Claims features include inventory tracking, task assignment and distribution, production planning, forecasting, KPI dashboards, activity monitoring, and query resolution. Quality teams can use configurable audits, sampling, capacity planning, error feedback, rebuttal workflows, and performance reporting. Contact-center features include member and call-history views, configurable workflows, real-time highlights, and performance analytics. Workforce dashboards help managers monitor productivity, workload, quality, and operational trends, while administrative tools support user and workflow management. The platform is delivered as a configurable SaaS service for payer operations; plan scope and pricing are tailored to customer requirements.
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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
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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
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Audience
Businesses in need of a tool to manage their claims adjudication processes
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Audience
Health insurance payers, third-party administrators, benefit administrators, and health plans; used by claims, quality assurance, member services/contact-center, and operations teams.
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Support
Phone Support
Supported
24/7 Live Support
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Online
Supported
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Support
Phone Support
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24/7 Live Support
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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
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Free Trial
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PricingFlexible payment options include monthly plans and pay-per-transaction billing. SaaS pricing is tailored to selected features and customer requirements; no long-term commitment is required.
Free Version
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Free Trial
Not Supported
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Reviews/
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Reviews/
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Training
Documentation
Not Supported
Webinars
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Live Online
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In Person
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Training
Documentation
Not Supported
Webinars
Not Supported
Live Online
Not Supported
In Person
Not Supported
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Company InformationComplete Health Systems
completehealthsys.com/claims/
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Company InformationMDI NetworX
Founded: 2014
United States
insightpro.ai/
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Integrations
No info available.
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Integrations
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