Audience
Companies searching for an intelligent claims administration system solution
About I-CAPS
I-CAPS is an Intelligent Claims Administration System that addresses all functional areas of the health claims payment environment with a single common architecture that spans the needs of payers including membership, billing, enrollment, mailroom, claims, network management, contracting, pricing, utilization review and customer service. Our Intelligent Claims Administration System (I-CAPS) and our coding compliance software (Advanced Value Scale-AVS) , support knowledge-based decision-making to help our clients contain costs. Guaranteeing the integrity of Provider information has never been easier with (Advanced Network Administrator-ANA) while our (RB-UCR) is the industry's first Resource-Based, Usual Customary, and RESPONSIBLE fee schedule based on RBRVS and NCCI. Need a check-up for your plan or provider, use Cost Containment Audit and Recovery Services (CCARS) for a completely noninvasive audit retrospective look at claims effectiveness.
Integrations
No integrations listed.
Company Information
W.O. Comstock & Associates
www.amrhealth.com
Videos and Screen Captures
Enterprise Health Solution
HM Health Solutions provides an end-to-end solution to health plans. Get the support you need and business outcomes you want from one comprehensive health plan administration platform: the Enterprise Health Solution. Platform applications and tools manage functions from sales through enrollment and billing, including claims, provider and clinical management, and customer service. The Enterprise Health Solution (EHS) is the only proven end-to-end solution, and can move your member seamlessly from enrollment to claims payment. You’ve heard others claim to offer a fully integrated solution. What they don’t specify is that you may need to purchase all modules in sequence to achieve this integration. On the Enterprise Health Solution, health plan administration has always been the one and only focus. No other company rivals our expertise in the health plan payer space.
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Virtual Examiner
Virtual Examiner®, PCG Software’s flagship product, monitors the internal claims process of an organization to trend provider data for fraudulent and abusive billing patterns, and maximizes financial recoveries. PCG Software’s Virtual Examiner® allows healthcare organizations to enhance their current claims adjudication system with more than 31 million edits per claim. The software solution monitors an organization’s internal claims process to identify unclean claims and reduce payment for improper or erroneous coding to conserve premium dollars. Virtual Examiner® is more than a claims review solution with a focus on code combinations. It is a cost containment solution that evaluates the claim not only for abusive billing patterns but also identifies those claims that may involve third-party liability/coordination of benefits, case management opportunities, physician billing education and many other cost recovery reports.
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Assurance Reimbursement Management
An analytics-driven claims and remittance management solution for healthcare providers who want to automate workflows, improve resource utilization, prevent denials, and accelerate cash flow. Increase your first pass claim acceptance rate. Our comprehensive edits package helps you stay current with changing payer rules and regulations. Heighten your staff’s productivity with intuitive, exception-based workflows and automated tasks. Your staff can access our flexible, cloud-based technology from any computer. Manage your secondary claims volume through automatic generation of secondary claims and explanation of benefits (EOB) from the primary remittance advice. Focus on claims that need your attention with predictive artificial intelligence into problem claims. Resolve errors faster, and avoid denials before submittal. Process claims more efficiently. Print and deliver primary paper claims, or add collated claims and EOBs for secondary claims.
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MediClaims
WLT’s MediClaims system offers a cost-effective, straightforward, and efficient approach to benefit and claims administration. WLT’s rules-based architecture and integrated EDI processes allow claims to be processed quickly, easily, and accurately. MediClaims’ administration and processing capabilities encompass a range of benefit and claim types, from Medical, Dental, Vision, and Prescription Drugs, to Consumer-Driven Healthcare, Disability, and Capitation processing. With WLT’s MediClaims system, you have the flexibility to configure your groups for a single line of coverage or for complex benefit packages with multiple lines of coverage. No plan can work efficiently without support from reliable information systems. WLT makes a point of always working with the most advanced technologies, providing you with the most sophisticated and flexible systems available today.
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Product Details
Platforms Supported
Windows
Training
Documentation
In Person
Support
Online
I-CAPS Product Features
Claims Processing
Claim Resolution Tracking
Adjustor Management
Case Management
Co-Pay & Deductible Tracking
Compliance Management
Customer Management
Electronic Claims
Forms Management
Paper-Based Claims
Payor Management
Policy Administration