Audience
Companies searching for a flexible workflow solution for automated processing of claims documents
About Sumex
Efficient checks, integrated expertise and a high degree of automation reduce the transaction costs of vouchers to a minimum. Sumex Core is the basis for automated electronic invoice verification. It contains the business components and workflows, which can be assembled and parameterized in a modular way. Current and correct tariff and reference data are central to efficient invoice verification. Sumex reference data is compiled from publicly available sources, processed in a timely manner and made available on the Sumex tariff server. The data is additionally presented in an information system and can be consulted directly by the experts in the context of the current billing. DRG Expert supports the controlling of billing for services in acute care, created according to SwissDRG regulations. DRG Expert presents case data in the context of regulations, contains statistical key figures and offers what-if analyses.
Service Center
Service Center by Office Ally is a trusted revenue cycle management platform used by over 65,000 healthcare organizations processing more than 350 million claims annually. With it, providers can verify patient eligibility and benefits, upload and submit claims, correct rejected claims, check claim status, and obtain remits. With multiple claim types and submission options, providers can easily submit claims to any payer from any practice management system. Transactions are secure, ensuring the confidentiality of sensitive patient information. With no needed implementation, providers can quickly and effortlessly streamline their billing processes, increase their financial performance, simplify medical billing, and reduce claim rejections for faster reimbursements.
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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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Claimocity
Claimocity was designed for busy clinicians who see patients in Acute Care or Step Down facilities. Claimocity is the first and only PM and RCM software designed exclusively for hospitalists. it is an All-In-One Mobile Billing & Practice Management Software App for Clinicians Who See Patients in Acute Care or Step Down Facilities. Clone previous notes in a way that other solutions, including EHR/EMRs, are not allowed to do. Combine and streamline two separate daily encounter documentation and billing processes in a way that saves significant time. Our note capture section can prepopulate the note with vitals and import elements from the chart. Support multiple complex templates inside a practice (calibrated encounter notes, procedure specific notes, single-section text based notes, or any combination of context-based pre-builds). Copy and paste any large available data groupings from third party available information sources directly into any text section and then sign and submit.
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Context 4 Health Plans Suite
Protect the integrity of your health plan and determine accurate pricing with the Context4 Health Plans Suite, our modular, cloud‑based technology platform. Immediate, actionable, and defensible Fraud, Waste, and Abuse (FWA) detection built by our team of certified clinical, dental, and health benefits experts. Accurate data and cutting-edge cloud technology combine to create a proven and defensible medicare reference-based pricing (RBP) solution. More than 100 healthcare data sets, with professional support to optimize efficiency and compliance. Advanced medical coding software designed to expedite claim submission and minimize denials. Our cloud based Payment Integrity Platform utilizes our proprietary analytics engine to identify coding errors, medical necessity, unbundling, fraud-waste-abuse, audit risks, pricing and other aberrations that can impact your business.
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Integrations
Company Information
Sumex
Founded: 2019
www.sumex.ch/en/Sumex-Suite
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Product Details
Platforms Supported
SaaS
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