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What is ImagineMedMC?

Leverage a cloud-based healthcare delivery system to efficiently oversee the healthcare services and networks for your members. This innovative system enhances claims processing for managed care organizations by automating essential tasks such as verifying eligibility, managing referrals and authorizations, handling provider contracts, overseeing benefit management, automating claims adjudication, administering capitation for both primary and specialty care, processing EOB/EFT checks, and facilitating EDI transfers and reporting. It can be deployed as a cloud solution or maintained on-site, making it an ideal option for various entities, including managed care organizations (MCOs), independent physician associations (IPAs), third-party administrators (TPAs), preferred provider organizations (PPOs), and self-insured groups. By streamlining the complex procedures associated with eligibility management, referral authorizations, and claims processing, this system significantly boosts operational efficiency. Its design prioritizes data integrity while reducing the reliance on manual data entry, leading to enhanced accuracy and productivity. Moreover, the adaptability of deployment options allows organizations to select the solution that best aligns with their specific operational requirements, ensuring they remain agile in a constantly evolving healthcare landscape. Ultimately, this comprehensive system not only improves day-to-day operations but also supports better healthcare outcomes for members.

What is Adjudicator?

Adjudicator functions as an innovative platform designed for the administration of plans and the evaluation of prescription claims, catering to a diverse range of entities, including pharmacy benefit managers, hospitals, health systems, managed care organizations, and retail pharmacies. This platform boasts customizable plan configurations and benefit structures, supports multi-tenant environments, and facilitates the oversight of pharmaceutical networks, drug formularies, and maximum allowable cost (MAC) pricing. Users gain access to a member portal that provides real-time information on benefit statuses and the ability to track pending claims, along with options for secure document uploads and timely alerts. Moreover, a prior authorization dashboard offers insights into claims data while fostering secure communication among various stakeholders. An integrated API framework allows for efficient data exchange with both internal systems and external partners, ensuring smooth interoperability. By equipping organizations with these robust tools, Adjudicator enables effective management of pharmacy benefits and prescription claims, significantly improving operational efficiency and the quality of service provided to members. Ultimately, the comprehensive features of Adjudicator allow stakeholders to remain agile in response to the dynamic landscape of healthcare and pharmacy management, ensuring they are well-prepared for future challenges.

Media

Media

Integrations Supported

Additional information not provided

Integrations Supported

Additional information not provided

API Availability

API Availability

Has API

Pricing Information

Pricing not provided

Pricing Information

Pricing not provided

Supported Platforms

SaaS

Supported Platforms

SaaS

Customer Service / Support

Standard Support
Web-Based Support

Customer Service / Support

Standard Support
24 Hour Support

Training Options

Documentation Hub
Webinars
Online Training

Training Options

Documentation Hub
Webinars
Online Training
On-Site Training

Company Facts

Organization Name

Imagine Software

Date Founded

2000

Company Location

United States

Company Website

www.imagineteam.com

Company Facts

Organization Name

Cervey

Date Founded

1978

Company Location

United States

Company Website

cervey.com

Categories and Features

Medical Billing

Code & Charge Entry
Compliance Tracking
Customizable Dashboard
Dunning Management
Invoice History
Patient Eligibility Checks
Practice Management
Quotes/Estimates
Remittance Advice

Categories and Features

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