Healthcare Programs

Who We Help

ACOs & IPAs

ACOs & IPAs

For IPAs, we provide an end-to-end revenue cycle management software solution for physician practices, labs, home health, medical billing services and other providers wanting to simplify workflows, reduce denials, optimize revenue and improve patient engagement. The solution can access patient eligibility from over 2,100 payers, estimate patient share with 90% accuracy and streamline management of patient payments.

For Medical billing and claims management, the solution ensures claims are correct before submission and prioritizes any that require attention, easily creates work queues to assign groups of claims for manual resolution, simplify claims tracking by viewing ERAs matched to original claim on the same screen.

To automate reject and denied claims process to enhance staff efficiency and accuracy, the solution applies AI and machine learning technology to predict denial candidates prior to submission. The dashboards and report make the revenue cycle visible uncovering the source of problematic trends such as repeated rejections helping IPAs implement solutions. The AI technology can also help IPAs make more informed and proactive decisions impacting the revenue cycle.

In addition, for ACOs and IPAs, we help increase revenue by reconfirming HCCs and CDPS, improving HEDIS scores and streamline communications with Payers.

Medicaid Plans

Medicaid Health Plans

Over the past five years, we’ve observed the uphill battle that has only grown steeper as private Medicaid plans increase enrollment. That’s why we’ve tailored our products to serve your needs and simplify efforts for HEDIS and CDPS. We’ve developed unique ways to manage these programs, and we look forward to telling you how we can help.

Commercial Health Plans

Commercial Health Plans

In today’s market, health plans distinguish themselves based on the quality of care they offer their membership. HEDIS is an important measurement that demonstrates how well health plans are performing with regards to health care quality. We’ve developed RAMP and HEDIS mobile-eXam to take your health plan’s Risk Adjustment and HEDIS results to the next level. Whether you’re in the commercial market or the exchange markets, we welcome the opportunity to learn about your objectives and tell the story behind our solutions for HEDIS, Risk Adjustment, and health plan operations.

Medicare Plans

Medicare Health Plans

We understand the challenges faced by Medicare Advantage plans as they compete to achieve the highest HEDIS and CMS Star Rankings, reconfirm HCCs, and manage the barrage of incoming data received daily. We’ve put our passion behind products that simplify HEDIS improvement, HCC reconfirmation, and data capture. We look forward to telling you about HEDIS mobile-eXam, RAMP, and our eCS Suite.