Payers Products and Services
July 2011
The Electronic File Solution (EFS) is a suite of hosted software services designed to help companies manage the storage, retrieval and retention of critical business records. The service can help organizations integrate long-term electronic records management into current business strategies and systems. A configurable administrative dashboard enables users to manage and retrieve all records archived in EFS. Secure 24/7 Web access is part of the package, which couples with document management systems and consolidates documents from legacy systems. Complete paper-to-digital conversion and classification services are available along with support for litigation holds and e-discovery.
May 2011
Ingenious Med’s 9,000 users can now access the charge and data capture platform virtually anywhere. Available for iPhone, iPod Touch and iPad.
February 2011
The accountable care solution for healthcare provider and payer organizations addresses the needs of Medicare ACOs as described in the Medicare Shared Savings Program, Section 3022 of the Patient Protection and Affordable Care Act, as well as commercial ACOs involving health plans. This solution features technology components common to both Medicare and commercial ACOs, including data aggregation, clinical data exchange, performance management and role-based security. A Web-based, hosted platform provides HIPAA compliance and role-based security along with ready access to information. All relevant data sets are covered, including inpatient claims, pharmacy, laboratory, ancillary, outpatient, demographic and membership data.
December 2010
CareAdvance Provider is an automated authorization portal for healthcare practitioners that enables direct communication between payers and providers. When a provider submits an authorization request through the portal, the CareAdvance Provider solution automatically generates a pre-determined set of questions that is sent back to the practitioner for answers. Those answers are then reviewed by the software, generating a score based on the member’s benefit plan and its associated medical policy. The request is automatically approved, rejected or filed for additional review.
December 2010
HighPoint Solutions has teamed with Siperian to create the ICD-10 Appliance, a master data solution that helps hospitals, healthcare systems and payers with ICD-10 compliance. The solution employs master data management principles and tools to create a central business management layer with ICD-9/ICD-10 mappings, translations and business rules that can be utilized by all applications. The appliance facilitates consistency in approach and rules when major commercial, off-the-shelf (COTS) applications are sourced from multiple vendors and integrated with internally developed applications. It also permits overrides or extensions based on customer, business process or function. The appliance can be updated.
November 2010
Nexalign iEXCHANGE is a Web-based, multi-payer solution that allows physicians to quickly and easily submit transactions to healthcare payers. It supports direct processing of inpatient and outpatient authorizations, referrals, treatment updates, concurrent reviews and extensions. iEXCHANGE can automate and approve up to 80 percent of referral requests, reducing administrative costs. The service gives the physician’s staff real-time access to member eligibility and processed transaction information with appropriate considerations for member confidentiality, increasing the amount and accuracy of data that health plans receive and helping to enable staff to focus on clinical management instead of administrative functions.
November 2010
AOD Online from MRO is a centralized tracking and reporting system that allows healthcare organizations to manage and resolve PHI disclosure challenges through enterprise-wide software. Healthcare organizations can use the application to help ensure that they are fully compliant with an array of state and federal regulations. Features include a customizable user interface and advanced reporting and analysis for consistent administrative oversight. MRO performs a thorough review and evaluation of a provider’s operational policies and work flows to assess how it is performing in relation to specific requirements. MRO then identifies what measures and programs are needed to stop improper disclosures.
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