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What is Complete Claims?

Claims adjudication services encompass a variety of sectors such as medical, dental, vision, and prescription claims, along with both short and long-term disability cases. These services can be accessed on-site with a license or through a hosted application model (ASP). Powered by Microsoft technology, the system employs an SQLServer database and a Windows front end for optimal performance. Our customer service team is highly esteemed, comprised of healthcare claims experts with at least 12 years of experience in the industry. Every support request is documented, allowing clients to track their status online. The system includes a plan copy and modification feature that enables quick implementation of changes. Auto-adjudication is facilitated through benefit codes built on business rules that take into account over 25 variables related to both claims and claimants, all processed by the adjudication engine. Submissions can be made in various formats, including scanned images, EDI, or traditional paper submissions. The system adheres to HIPAA EDI 5010 transaction sets, guaranteeing secure and efficient processing. Furthermore, re-pricing fees and UCR schedules can be entered into the system ahead of their effective dates, while the date-driven logic ensures re-pricing is executed based on the service date, enhancing the overall workflow of claims processing. This comprehensive solution not only streamlines claims management but also significantly improves client satisfaction and operational efficiency.

What is ClaimScape?

Established in 2000, DataGenix focuses on providing cutting-edge claims processing solutions tailored for third-party administrators, adjusters, and insurance companies. Understanding the intricate challenges associated with claims processing and the management of health benefits, our expert team has created the advanced ClaimScape software to optimize the entire adjudication workflow, safeguarding your business from potential financial setbacks. Our goal is to address the obstacles that hinder a stellar customer experience for your clients. By staying attuned to contemporary trends and needs, we are devoted to supporting your organization’s expansion through our innovative software solutions. Recognized by top TPAs across the nation, we are enthusiastic about reaching a wider audience with our services. As we progress, our aspiration is to redefine industry benchmarks for excellence and reliability. Our commitment to innovation ensures that we will continually adapt to meet the evolving needs of our clients.

Media

Media

Integrations Supported

Additional information not provided

Integrations Supported

Additional information not provided

API Availability

Has API

API Availability

Has API

Pricing Information

Pricing not provided.
Free Trial Offered?
Free Version

Pricing Information

Pricing not provided.
Free Trial Offered?
Free Version

Supported Platforms

SaaS
Android
iPhone
iPad
Windows
Mac
On-Prem
Chromebook
Linux

Supported Platforms

SaaS
Android
iPhone
iPad
Windows
Mac
On-Prem
Chromebook
Linux

Customer Service / Support

Standard Support
24 Hour Support
Web-Based Support

Customer Service / Support

Standard Support
24 Hour Support
Web-Based Support

Training Options

Documentation Hub
Webinars
Online Training
On-Site Training

Training Options

Documentation Hub
Webinars
Online Training
On-Site Training

Company Facts

Organization Name

Complete Health Systems

Company Website

completehealthsys.com/claims/

Company Facts

Organization Name

DataGenix

Date Founded

2003

Company Location

United States

Company Website

datagenix.com

Categories and Features

Claims Processing

Adjustor Management
Case Management
Claim Resolution Tracking
Co-Pay & Deductible Tracking
Compliance Management
Customer Management
Electronic Claims
Forms Management
Paper-Based Claims
Payor Management
Policy Administration

Categories and Features

Benefits Administration

COBRA Administration
Claims Management
Deduction Management
Disability Insurance Administration
Employee Benefits Administration
FMLA Administration
FSA Administration
Flexible Spending Accounts
For Brokers
For Employers
HIPAA Compliant
Health Insurance Administration
Life Insurance Administration
Online Benefits Enrollment
Premium Billing
Provider Management
Retiree Administration
Retirement Plan Management

Claims Processing

Adjustor Management
Case Management
Claim Resolution Tracking
Co-Pay & Deductible Tracking
Compliance Management
Customer Management
Electronic Claims
Forms Management
Paper-Based Claims
Payor Management
Policy Administration

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