Top 10 Best Claims Processing & Claim Work Flow Software Administration

Top 10 Best Claims Processing & Claim Work Flow Software Administration
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The health of a company highly depends on how the company views and treats employees, assets, working conditions, and work facilities. Showing employees your organization cares about their occupational safety, hazards, and work conditions is key in retaining good employees, reducing turn over, lowering recruiting costs, and of course occupational injuries. Claims processing software is a critical component of this aspect of any business. There are many unseen consequences to mishandling claims or having inefficiencies throughout the claims processing steps within an organization.

Take a closer look at your organizational policies, and you will find that employee occupational safety is not the only aspect of claims processing systems for a business, as claims management systems involves how customer claims are handled, as well as company assets and equipment. Custom service claims such as issue tracking and support tickets protect an organization from customer disputes, while helping customer support staff better track customer service or product issues to closure. Giving employees tools to remain organized and prioritize which claims to tend to first, and to communicate effectively with customer claimants.


From a financial perspective, enhancing claims administration is a cash cow for any business. For businesses with little or no attention given to claims systems, revamping claims processing is an untapped gold mine for cost savings with, in some cases, an immediate ROI just for deployment. Aside from data input efficiencies, the ability to distribute claim notifications for asset, customer service, work hazards, facility maintenance issues, or employee injury claims carries a value unto itself with the opportunity for immediate actions. Additional regulatory fines may be avoided for claims that fall under OSHA, hazardous materials, MSHA, Department of Transportation, and Department of Labor regulatory requirements. The burden of collecting information that winds up being illegible, or even incomplete, is significantly reduced with online claim forms. Processing claims no longer needs to be limited to internal administrative staff with limited access to claimant and 3rd party information. Claimants, 3rd parties, and witnesses can have first hand access to secure electronic claim forms online.

Protecting company assets is also a primary benefit with claims processing software. Claims processing steps will vary depending on the nature of the asset claim, and properties of the asset, such as owner, value, maintenance requirements, and warranty contract. Large insurance companies traditionally have their claims processing evolved through years of refinement. Non-insurance companies, and small to mid-sized businesses may little or no investment of time and technology into their claims processing standards and efficiency.

Historically, claims processing systems and training has been cost-prohibitive to small businesses, preventing them from taking advantage of how software and internet technology can revamp claims processes and significantly reduce the number of steps involved. Claims may also require a substantial amount of information be moved between claimant parties, witnesses, and insurance companies. Information management and movement is critical in maintaining claim data integrity, for sorting claim information, approving claim expenses, and setting property and injury reserves.

The health and reputation of your company and it’s relationships greatly depends on how effectively your organization processes claims. Considering claims processing software now offers an entry point with litte or no up front investment, there is every reason to further look into how to process claims more effectively.


PEGA

Explore business solutions from the leader in software for customer engagement and digital process automation, built on the unified Pega Platform.

  • Intelligent data capture for FNOL, NOL, and FROI, with dynamic flows and forms that respond to the customer’s needs
  • Support for multi-channel claims entry via mail, fax, contact center, Internet, or email
  • Data integration for all types of information including databases, flat files, images, PDF, and major APIs
  • Comprehensive case management tools, with built-in SLA performance tracking
  • Early detection and alerting for patterns indicating potential fraud
  • Self-documenting processes that simplify auditing and compliance reporting

ABBYY

ABBYY’s leading AI and machine learning technology solutions range from process analysis, data capture, pdf editor, text and content recognition (OCR) and extraction, combining process and content insights to deliver digital intelligence.

  • Automatic capture of data from black & white and dropout forms with equally high quality
  • Processing of various medical claim forms, including HCFA/CMS-1500 and UB-04/CMS-1450, in a single batch with classification
  • A set of captured fields that is customizable to your requirements
  • Automatic validation of data against lists of ICD and CPT codes and rules to meet requirements imposed by CMS
  • Recognition of supporting documents attached to a claim, such as remittance advice or an explanation of benefits
  • Distributed scanning and submission of claims via a web browser, in addition to centralized capture

COMINDWARE

Comindware Business Application Platform is built using state-of-the-art technologies that enable quick and easy enterprise application development and deployment.

  • Design and Launch your Business Applications with No Coding
  • Mix and Match Projects, Processes and Cases
  • Make Changes “On the Fly”
  • Enhance User Experience
  • Maximize Productivity
  • Seamlessly Integrate with Other Enterprise Apps

NUXEO

Nuxeo offers claims management software solutions that empower insurance companies to drive a unified, omnichannel claims experience.

  • Data + Content
  • Federated access
  • Maximum performance
  • Cloud-native architecture
  • Continuous innovation
  • Low-code
  • Business specific AI

CLAIMVANTAGE

Industry-leading software for managing Life, Health and Absence claims efficiently and securely, to deliver superior customer service for a competitive edge.

  • One Central Platform
  • Deep Configurability
  • Reduce Operational Effort
  • No More Manual Processes
  • Gain More Knowledge

POKITDOK

PokitDok is a healthcare API platform that makes it faster and easier for you to bring new healthcare applications and services to market.

  • Automatically populate claims data into dashboards & reports
  • Verify patient coverage at time of service
  • Catch mistakes before submitting claims
  • Understand what claims need your attention

APEXEDI

Apex EDI is a leading electronic claims clearinghouse for healthcare professionals in the medical, dental, optometry, chiropractic, and other health industries.

  • Send Insurance claims electronically with the Apex OneTouch® service
  • Verify patient Eligibility benefits in real-time (270/271)
  • Online Claim History — with Apex EDI Real-Time Scrubbing
  • Unlimited Apex EDI claims support and customer service
  • ERA 835 Transactions (EOB) available
  • Custom advanced Claim Status reporting and searching functionality
  • Low monthly fee for electronic claims processing with no contracts
  • Send and organize patient Statements – with real time processing

PLEXISHEALTH

PLEXIS is a leading payer technology company that delivers trusted core administration and claims processing solutions to healthcare payers around the globe.

  • Application interface connectivity to connect your entire business ecosystem
  • High technological performance from our rules-based engine to deliver exceptional levels of auto-adjudication
  • Automated claim editing solutions to increase payment integrity and accelerate adjuciation
  • Intelligent alerts and reporting for time-saving, automated business activity monitoring (BAM)
  • Cost-saving electronic data interchange (EDI) solutions

ACTICO

ACTICO Software supports insurers in the AI-enabled and rules-based digitalization of their claims processes.

  • Intelligent Automation
  • Machine Learning & AI
  • Digital Decisioning
  • Business Rules

FINEOS

FINEOS provides a complete AdminSuite software solution for the life, accident & health insurance industry.

  • Suite of modern SaaS applications delivered on the FINEOS Platform
  • Designed for mission critical use by the smallest teams and largest multi-national carriers
  • Ready to use integration APIs for common integration points including CRM, Financial, DMS, CCM, HRIS, Policy, Enrolment, Data lake and warehouse.
  • Highly configurable platform to adapt to your business without code-based customization
  • Digital Service APIs to engage with existing portals, mobile apps, messaging and voice-based customer service technology for group and individual business stakeholders