Product Listings
RevCycle Engine (RCE) is a rules-based automation platform that helps revenue cycle teams reduce manual work and improve claim accuracy. It identifies and corrects coding and charge errors before claims are submitted, helping lower denial rates. RevCycle Engine includes built-in rules and allows customization to meet specific payer or organizational needs. Claims that need review are routed into work queues, allowing staff to focus on high-priority cases.
RevCycle Engine is designed to reduce administrative burden, improve clean claim performance, and integrate with existing billing systems. It supports efforts to make revenue cycle operations more efficient and responsive to changing requirements.
Zelis Claims Editing is a software designed to assist healthcare payers and providers in managing the accuracy and compliance of health insurance claims. The software automates the process of identifying errors, inconsistencies, or deviations from standard billing practices within submitted claims. It integrates with claims processing systems to analyze and validate coding, modifiers, and medical necessity based on industry guidelines and payer policies. The software aims to reduce improper payments, streamline adjudication, and enhance operational efficiency in claims management. By applying configurable rules and edits, it helps organizations address claim discrepancies and control costs associated with claim rework and denials.
Alaffia Health Next-Generation Claims Editing is a software designed to support healthcare payers in reviewing and optimizing medical claims. The software employs automated data analysis to detect anomalies, inconsistencies, and errors within claims submissions. It features tools that allow for the identification of incorrect or duplicate billing, improper coding, and potential overpayments. By streamlining claims auditing, the software helps organizations reduce administrative costs and enhance payment accuracy. Its decision-support capabilities enable payers to improve compliance with regulatory requirements, mitigate fraud risks, and address billing discrepancies more efficiently. The software integrates with existing claims management workflows to support operational efficiency and informed decision making.
Aptarro ClaimStaker is a clinical claim scrubbing platform that reviews medical claims before submission to help identify coding, billing, and payer-specific issues. The platform applies a broad set of clinical and billing rules and updates its content regularly based on regulatory and payer changes. ClaimStaker can be used on its own or integrated with PM and EHR systems, providing users with clear edit details to support timely corrections. It also includes reporting capabilities that help organizations monitor claim trends, track accuracy, and support oversight. Healthcare organizations use ClaimStaker to reduce avoidable denials, limit rework, and improve the efficiency of their revenue cycle processes.
BeaconLBS is a software designed to support pharmacy benefit management and prescription adjudication workflows. The software provides location-based services and analytics aimed at facilitating coordination between pharmacies, payers, and health care providers. BeaconLBS automates claim processing, assists in network management, and supports clinical decision-making by delivering real-time information on prescription activity. The software addresses challenges related to prescription authorization, drug utilization review, and compliance with regulatory standards. It offers tools for reporting, workflow optimization, and communication between stakeholders to improve the efficiency and accuracy of pharmacy-related operations.
Claims Corner is a software designed to streamline the management of insurance claims for healthcare providers and payers. The software facilitates the processing, submission, and tracking of medical claims, helping users to manage documentation and resolve claim issues efficiently. It offers features such as claim status inquiry, error identification, and resolution support, which help reduce delays and administrative burdens in the claims workflow. Claims Corner assists organizations in maintaining compliance with billing regulations, improving accuracy in claims submissions, and enhancing operational transparency. The software aims to solve common business problems related to claim denials, reimbursement management, and communication between healthcare entities and insurers.
Cotiviti Coding Validation is a software designed to assess and verify the accuracy of medical coding in healthcare claims. The software uses advanced analytics and automation to identify discrepancies, inconsistencies, and errors in submitted codes, enabling healthcare organizations to ensure compliance with coding standards and reduce the risk of incorrect billing. By providing detailed feedback on coding practices, the software supports the identification of training needs and helps improve overall coding quality. Cotiviti Coding Validation addresses the business need for precise claims processing and supports efforts to minimize payment errors and optimize reimbursement outcomes.
Optum Claim Edit System is a software designed to enhance the accuracy and efficiency of healthcare claims processing. It provides automated review and validation of medical claims by applying rules and edits to identify discrepancies, omissions, or coding errors. The software aims to reduce claim denials and payment delays by ensuring claims compliance with payer requirements and regulatory standards. It supports healthcare organizations in improving operational workflows by flagging errors before claims submission and offering corrective guidance to help resolve identified issues. Optum Claim Edit System addresses challenges related to claim accuracy, compliance, and administrative burden in claims management.
Pareo Audit is a software designed for healthcare organizations to manage payment integrity and audit processes. The software enables users to identify, prevent, and resolve overpayments by automating workflows and providing analytics for claims review. It supports audit operations by facilitating collaboration between internal teams and external vendors, tracking case progress, and centralizing audit documentation. Pareo Audit addresses the business problem of reducing financial losses due to claim inaccuracies and inefficiencies in audit processes, allowing organizations to optimize operational performance in payment verification and recovery efforts.
PLEXIS Claims Editing is a software designed to facilitate the analysis and management of healthcare claims by identifying errors, inconsistencies, and potential compliance issues before claims are processed. The software integrates rules-based editing to automate detection and correction of claim inaccuracies, which supports regulatory compliance and reduces the rate of denied or delayed claims. It addresses the business problem of administrative inefficiency and revenue loss due to improperly submitted claims by enabling payers and administrators to improve the overall quality and accuracy of claims processing. It offers configurable rule sets, real-time and batch processing, and integration capabilities with other core administration systems to streamline claims workflows.
Source Editing is a software designed to enable users to modify, manage, and validate healthcare benefit plans and claims processing configurations. The software provides tools that allow users to edit source code and business rules within healthcare administrative systems, aiming to improve accuracy and compliance in benefit management workflows. By facilitating efficient source code adjustments and configuration changes, the software addresses operational challenges related to the implementation of updates and regulatory requirements. The software is used by organizations seeking to streamline their healthcare plan administration processes and enhance the precision of claims adjudication.