Optum360 is a platform that helps organizations to provide amazing financial experience to their patients, and it helps in accelerating cash flow through claims management. The platform comes with a built-in payer-provider that allows companies to verify their insurance eligibility and eases up uncertainty for both customers and companies.
The solution helps companies to accelerate their collection process, reduces the denials, and improves patient satisfaction as it offers easy payment options to the patients. It sends details about the claim to the patients even before they leave the system. The platform’s proactive approach helps in improving the integrity of the claim management processes and avoids any kind of delay.
Optum360 allows organizations to improve the A/R recovery and reduce denials with a single customized solution, and it customizes the relationship of patients according to the situation. It allows users to create clinical documentation and helps companies to achieve regulatory compliance.
#1 TriZetto QNXT
TriZetto QNXT is a comprehensive solution of modules that include everything for users to manage their data and operations regarding health claims and cases. The platform offers various functions, such as medical and specialty claims processing, premium billing, and referral management. It is built in an open platform, which helps in delivering necessary flexibility and functionality to improve the performance of operations.
The platform enables users to prioritize and reduce pending and exception claims by increasing automation and improving operational efficiency. It automatically manages claims in real-time to work queries and offers automatic identification of work items on the basis of lines of business.
TriZetto QNXT comes with an Appeal and Grievance routing feature that helps users in managing the complain process and electronically routing it to the right person. Its claims adjudication management feature enables users to avoid growing backlog and helps in maintaining the inventory of documents.
AdvancedBilling is medical billing software that enables users to automate their tasks and helps in revenue capturing. The solution is very helpful for small and medium-sized healthcare facilities and clinics. It comes with a ClaimInspector feature that enables users to check errors in claims prior to their submission automatically.
The platform’s claims center offers auto-generated worklists and centralizes billing for multiple providers. Moreover, its ClaimInspector can run millions of edits for every claim to check requirements according to HIPAA and CCI, etc. The software allows users to track and manage their accounts receivable on a daily basis.
AdvancedBilling comes with an interactive dashboard that allows users to process statements and send electronic letters to their clients. The platform’s claim management feature enables users to handle everything efficiently, from charge capturing to reimbursement. Lastly, other key features are Centralized Billing, Credit Card Processing, Batch Process Patient Billing, and Patient Statements.
CareCloud is a platform that helps medical facilities to manage their finances and workflows at the speed of their practices and allows them to fulfill the satisfaction of their patients. The platform offers a complete revenue cycle management, which enables them to stay focused on their patients while the software manages their payments.
The solution offers real-time analytics to help them in improving their profitability and eliminates administrative burdens. Moreover, its collection experts and specialized billing optimize the payment cycle. Its Collective IQ enables organizations to minimize denials and get paid faster.
The platform helps teams to get rid of burdens such as working denials, issuing patient statements to keep their focus on the patients. CareCloud allows users to get their claims quickly to the system, whether they are in paper or electronic form. Lastly, it sends invoices to the patients on behalf of the organizations.
Snapsheet is a claim management system that enables users to streamline their document process, optimize the payments, and manage their assets. It allows organizations to digitize their claim processes, and it has a customer-oriented approach to deliver fast with a better experience. Moreover, it enables the users to build their automated claim experience in no time with a limited amount of money.
The solution enables users to reach the right people at the right time and engage them in communication. It empowers agents to generate such configurable workflows that streamline and automate claim processes and helps managers to manage their teams.
Snapsheet enables agents to get a consolidated view of all of their claim information, and they can extend the capability of their claim management system by integrating third-party platforms. It delivers scalable test and A/B testing capabilities, and through its omnichannel communication feature, it keeps everyone in the loop.
BriteCore is a platform that provides services to insurance companies in property and casualty insurance cases and supports them in the digital transformation of their system. The platform enables the employees to collaborate from anywhere using the web-based tools and solve their everyday business challenges faster. It streamlines all the tasks and optimizes workflows to help customers and agents in the doing business.
The solution comes with a policy management tool that allows users to manage all of their policies and helps in automating their documentation processes. It offers a billing feature that helps users in managing the full billing lifecycle.
BriteCore offers an administration and claims management process to handle all end-to-end claims processes, and its web-based portal allows users to quote and view policies from anywhere. It comes with business intelligence and analytics that provide reports to users to get useful insights. It has role-based access to keep documents secure.
ClaimCenter is a service provider to organizations to help to resolve their claims faster and to exceed their customer expectations. The solution enables organizations to optimize all of their processes by reducing their cycle times of processes and resources and allowing the staff to get access to real-time information. It allows the managers to define how and when reserves and activities are created.
The platform allows users to keep their activities and processes customer-centric to provide an amazing experience. Moreover, it enables users to empower their customers with digital self-service channels, and it ensures reliability on third-party service.
ClaimCenter allows users to embrace emerging technologies more freely, and they can extend the capabilities of their claims operations with different pre-built apps. Moreover, users can fuel up decisions in the right direction with the help of artificial intelligence. Lastly, it allows users to scale compliant with the rules and security measures.
athenaCollector is a platform that helps users to get access and share patient data across different platforms and allows users to generate invoices and get paid instantly. The solution contains complete medical records that they can access anytime and can get them in proper documentation. It enables users to collect bills faster, and users can stay up-to-date with the missing collections.
The platform enables users to stay alert with any kind of claims error before any employee makes them, and it keeps updating the claims management rules. Moreover, it optimizes the appointment feature to helps users in scheduling their appointments with the clients and get automated reminders.
athenaCollector allows users to verify the patient’s eligibility in advance and can collect payments from the patients at the time of service. Moreover, it allows users to create performance reports that help users to make data-driven decisions, which helps them in making their work-process better.
#8 Applied Epic
Applied Epic is a platform that offers an insurance solution that helps insurance providers in the exchange of insurance data. The solution allows organizations to compare and verify policies and contracts. Moreover, it enables users to plan summaries and contracts of users by using the pre-built forms and templates.
The platform also enables organizations to educate their employees on government-mandated benefits and helps them in day-to-day insurance processes. Moreover, it allows users to manage their sales processes, and managers can manage and view the performance of their sales agents through the agent dashboard.
Applied Epic offers sales automation features to the sales teams to help them in managing their sales activities more efficiently. Moreover, it also allows agents to create documents and reports on their clients, and they can manage these documents in different folders on the software. Lastly, agents can communicate with their customers through the software.
#9 FINEOS Claims
FINEOS Claims is a software that helps customers to claim their insurance in the case of accident and health. The platform offers both individual and group claims services, and it can handle thousands of customers at a single time. It enables organizations to understand and increase their knowledge about their customers, and users can increase customer retention through the software.
The platform enables organizations to optimize and reconfigure the claims process to meet and gain insights into the changing situations. Moreover, it helps users to improve their customer service and gain detailed audit trails of their claim processes.
FINEOS Claims enables users to achieve better claimant outcomes by reducing claims durations through improved rehabilitation and better claim management. Moreover, its AdminSuite offers billing features that help in reducing billing leakage and automated cash applications. Lastly, it allows users to increase accuracy and compliance of their claims and helps in driving outcome-orientated engagement.
#10 A1 Tracker
A1 Tracker is a software that helps companies to manage their risks more efficiently and helps them in keeping their business processes smooth. The platform allows users to track risks and incidents through its web-based system. It offers real-time notifications to users to keep them alert about the emerging risks in any department.
The software offers customizable dashboards, metrics, and other integrations to help users in their claim management and asset management processes. It offers a claim management software that enables users to view the details, notes, and history of claims. It allows users to track claims of different types, such as hazard reports, omission claims, etc.
A1 Tracker comes with a claim portal that allows the organization to process customer’s application by following one step at a time to stay compliant to the standards. Its insurance software enables users to track policies and certificates for various types of insurances.
#11 FileHandler Enterprise
FileHandler Enterprise is a claim management system that enables companies to automate their workflows for risk management processes. The platform also offers dashboards and business intelligence tools to helps users set the benchmark in the claims management system. It offers different processes to administer claims, payment, and employee data to manage their business effectively.
It is a user-friendly software and helps in performing claims management tasks quickly, and users can define their business rules in it. Moreover, the platform also allows users to organize their tasks, and it comes with features, such as Audit Functionality, Report Scheduling, Notification System, and much more.
FileHandler Enterprise comes with many third-party integrations to help users perform their tasks efficiently, such as PBRV, TPAs, Payroll, Carriers, ACH with Banking, etc. Moreover, it converts all the data into rich-visual reports to helps users view and understand the situation of their performance.
WellSky, formerly Kinnser, is a healthcare solution provider that offers home health, blood management, hospice, and much more. It also offers instant Medi-Span drug database screening, fast scheduling, and OASIS checks. You can customize it to serve hospice, therapy, and private duty agencies. WellSky offers tools to optimize intake, manage patients’ bookings, track referrals, and manage authorization and eligibility. Doctors and their staff members can prioritize patient care, schedule daily appointments, manage documentation, and more.
The internal email messaging system allows users to attach messages about patient care directly to the patient’s chart. WellSky software optimizes intake, eligibility checks, and calendar management. Your company will be able to receive referrals seamlessly and securely, manage authorizations and eligibility easily, see all visits by disciplines on one calendar, and schedule entire episodes of care in seconds. All in all, WellSky is a great healthcare management tool that you can consider among its alternatives.