Product Listings
TriZetto Facets Enterprise Core Administrative Platform is software designed to support health plan operations through integrated administrative functions. The software enables management of core business processes such as claims processing, member enrollment, billing, provider network administration, and benefits configuration. It facilitates interoperability among systems and offers tools for workflow automation and data analytics, contributing to operational efficiency and accuracy. This software addresses the business need for scalable and adaptable administrative solutions in health plan management, assisting organizations in simplifying complex administrative tasks and improving the quality of service delivery.
TriZetto QNXT Enterprise Core Administration System is a software designed to support health plans in automating and managing core administrative processes. The software provides functionality for member enrollment, claims processing, benefits administration, provider network management, and billing activities. It offers configurable workflows and helps organizations streamline business processes, improve data accuracy, and maintain compliance with regulatory requirements. TriZetto QNXT Enterprise Core Administration System aims to facilitate integration with other systems and supports reporting and analytics for operational insights. This software is intended to address business challenges related to efficiency, scalability, and administration within healthcare payer organizations.
Accenture Health Administration BPO Services is a service designed to support healthcare organizations with administrative and operational processes. The service provides solutions for claims management, member services, provider network management, and billing processes. It automates tasks such as enrollment, eligibility verification, and payment processing to increase accuracy and reduce manual workload. This service addresses challenges related to efficiency, compliance, and scalability by applying analytics and digital technologies to streamline business functions. Organizations using this service can improve processing times and manage health plan administration more effectively, which helps minimize errors and enhances operational productivity.
Aspen Web Portals is a software designed to support health plan administration by providing secure online access to benefits, claims, eligibility, and member data. The software offers features such as real-time information retrieval, document management, and communication tools for members, providers, brokers, and employers. Aspen Web Portals streamlines business processes by enabling users to view statements, submit claims, access important resources, and manage enrollment. The software aims to address the need for efficient self-service and data transparency within healthcare organizations, allowing stakeholders to reduce administrative workload and improve operational efficiency while maintaining compliant and secure data access across multiple user groups.
Burgess Source is a software developed by HealthEdge designed to support healthcare organizations in automating the management of payment integrity and claims pricing. The software enables users to maintain and apply payment policies, edits, and rules in the adjudication process, helping organizations ensure consistency and accuracy in claim payments. Burgess Source integrates with existing core administration platforms, provides tools for modeling and simulation of payment policies, and supports compliance with regulatory and contractual obligations. Through streamlined workflows and analytics capabilities, the software addresses challenges related to complex healthcare payment processes while aiming to minimize errors and improve operational efficiency.
Core Stack 2.5 is a software that facilitates claims administration and management for health plans and third-party administrators. The software provides features that handle member enrollment, eligibility verification, claims adjudication, provider management, payment processing, and reporting. It enables organizations to streamline operational workflows by automating tasks related to health benefits administration. The software aims to address business challenges of efficiency, accuracy, and compliance in managing healthcare claims and member information. Through its core functionalities, Core Stack 2.5 supports scalability and integration with other enterprise systems, helping organizations optimize processing and reduce manual workload in healthcare administration.
Enterprise Health Solution is a software designed to support healthcare organizations in managing operational workflows and data. The software provides capabilities for electronic health records management, patient scheduling, and clinical documentation. It streamlines processes such as billing, reporting, and regulatory compliance while facilitating interoperability between various healthcare systems. By integrating patient information and administrative tasks, the software aims to enhance efficiency and accuracy in healthcare delivery, addressing challenges related to record keeping, patient care coordination, and resource management.
Healthcare Administration is a software developed to support the management of administrative processes within healthcare organizations. The software streamlines tasks such as patient registration, appointment scheduling, billing, insurance claims processing, and medical record management. It is designed to help healthcare providers improve operational efficiency by automating routine administrative activities and enabling centralized data management. Healthcare Administration also supports regulatory compliance by maintaining secure records and facilitating accurate reporting. The software addresses the business problem of reducing administrative overhead and minimizing errors commonly associated with manual processing in healthcare environments.
Healthcare Claims and Member Management Operations software streamlines administrative processes for health plans by automating claims adjudication, member eligibility verification, enrollment, and benefits administration. The software manages provider networks, facilitates claims processing, and supports compliance with industry regulations. It aims to increase operational efficiency and accuracy by integrating data from multiple sources, offering tools to identify discrepancies, enhance reporting capabilities, and support analytics. The software addresses business challenges related to managing large volumes of healthcare transactions and membership records, helping organizations reduce manual intervention and improve payout cycles while ensuring data integrity throughout core operations.
Healthcare Core Administrative System is a software designed to manage core administrative processes for healthcare organizations. The software supports claims processing, provider management, member eligibility verification, and benefit administration. It facilitates automation of routine tasks, streamlines billing and payments, and ensures compliance with regulatory standards. By centralizing essential functions, the software helps reduce operational inefficiencies and supports accurate data management, enabling healthcare organizations to efficiently handle administrative requirements and improve overall workflow.
Healthcare Solutions is a software developed by Vee Technologies that offers a suite of features designed to address various operational and administrative requirements in the healthcare industry. The software streamlines processes such as revenue cycle management, medical coding, risk adjustment, and payer solutions. It enables organizations to improve workflow efficiency, manage patient data, enhance billing accuracy, and ensure regulatory compliance. The software supports healthcare providers in addressing challenges related to financial performance, data management, and claims processing. Healthcare Solutions helps optimize resources and reduce operational complexities associated with healthcare administration.
HealthRules Answers is a software that provides business intelligence and analytics capabilities for healthcare organizations. The software enables users to access and analyze claims, member, provider, and financial data from core administrative systems. It offers configurable dashboards and reporting tools to support operational and strategic decision making. HealthRules Answers helps organizations identify trends, monitor key performance indicators, and address compliance requirements by delivering insights into cost, utilization, and process efficiency. The software is designed to streamline data gathering, improve reporting accuracy, and support transparency in healthcare management.
HealthRules CareManager is a software designed to support care management and coordination processes for health plans and other organizations in the healthcare industry. The software enables users to manage care plans, identify and address gaps in care, monitor patient progress, and analyze population health data. HealthRules CareManager provides tools for case management, disease management, and utilization management, helping organizations streamline workflows and improve communication among care teams. The software aims to address business challenges related to care coordination, regulatory compliance, and quality reporting, offering configurable workflows and integration with other healthcare systems to facilitate efficient care delivery and improve health outcomes.
HealthRules Connector is a software designed to facilitate integration between healthcare payer core administration systems and external applications. The software supports data exchange, streamlines workflows, and automates complex information transfers across various platforms. It enables connectivity with partners, vendors, and other third-party systems while maintaining data integrity and compliance. HealthRules Connector addresses the business problem of siloed systems by providing tools for secure interoperability and efficient management of information, allowing organizations to adapt to regulatory changes and operational requirements. It is used by healthcare payers to enable seamless connections, automate processes, and ensure accurate and timely data movement between business-critical systems.
HealthRules Payor is a software designed to support health insurers in managing claims processing, benefits administration, and member enrollment. The software enables configuration and automation of benefit plans, supports compliance with industry regulations, and facilitates integration with other healthcare IT systems. HealthRules Payor aims to streamline operational workflows by providing tools for premium billing, provider contract management, and utilization management. The software focuses on helping organizations address challenges in processing high volumes of transactions, reducing errors, and improving overall efficiency in health plan administration. It offers scalable solutions for different types of health plans, including commercial, Medicare, and Medicaid, and provides analytic capabilities for reporting and decision support.
HealthRules Portal is a software developed by HealthEdge that enables health plan members and providers to access secure, real-time information related to claims, benefits, eligibility, and authorizations. The software integrates with core administrative systems to deliver personalized communication and support self-service capabilities, allowing users to review plan coverage, submit and track requests, and manage records. HealthRules Portal addresses the need for efficient interaction between health plans and users by streamlining administrative tasks and reducing dependency on manual processes, contributing to improved transparency and operational efficiency in healthcare management.
HSP Payer Suite is a software designed to help healthcare payers manage and automate their claims processing, billing, and payment operations. The software supports electronic transactions and facilitates compliance with industry standards such as HIPAA. It offers features for member management, provider management, benefits administration, and reporting, aiming to streamline workflows and improve the accuracy of data exchange. HSP Payer Suite assists organizations in addressing business challenges related to administrative efficiency, regulatory adherence, and transaction interoperability within the healthcare sector.