Disease Risk Prediction
Action Recommenders
Multi Therapeutic Areas
Personalized Care Plan
Algorithmic Treatment Pipeline
CheckHigh Risk Member Identification
Member Outreach Scheduling
Risk Assessment
Personalized Care Plan
Duplicate Case Identification & Merge
Eligibility Management
Questionnaire Management
Member Clinical History Data Gathering
Member Correspondence Letter Generation
Scheduling Appointments
Monitoring Progress
Revenue Cycle Management
Prior Authorizations
Insurance Claims – Posting
Patient Payment – Posting
Coordination of Benefits: Primary, Secondary, Tertiary
Price Transparency & Real-Time Estimates
Revenue Integrity – Payment Audits (Under & Over)
Provider: Insurance Enrollment
• Revenue Integrity – Charge Description Master (CDM) Management • Revenue Integrity – IME/IMR Audits (CMS & Medicare Advantage) • Insurance Claims – Denied & Rejected Follow-U CheckMulti-Channel Intake Member & Provider Info Edits Member Eligibility Validations Medical Necessity Validations Review Case Determination Claim Processing Audit Claims Adjudication Claim Payment Adjustments High Dollar Claims Audits Post-Authorization Case Review
Member & Provider Info Edits
Member Eligibility Validations
Simplify & modernize claims processes.
Making claims decisions doesn't have to be a highly manual process with a high administrative price tag to match. Intelligent business automation empowers you to reduce errors while making adjudication processes hands-free.
Task
Rebuild a unified healthecare system.
CheckHigh Risk Member Identification
Member Outreach Scheduling
Risk Assessment
Personalized Care Plan
Duplicate Case Identification & Merge
Eligibility Management
Questionnaire Management
Member Clinical History Data Gathering
Member Correspondence Letter Generation
Scheduling Appointments
Monitoring Progress
Care Management
As a key healthcare partner, you want to deliver innovative programs that help improve clinical outcomes and ensure at-risk members get treatment on time. With a full view of patient health information, as well as individualized member insights, you can collaborate with providers and engage with members effectively.
Task
Automate Care Manual data entry and processing.
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