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What is Sumex?

Efficient verification methods, paired with expert knowledge and a high degree of automation, greatly reduce the costs associated with voucher transactions. Central to this operation is Sumex Core, which underpins the automated validation of electronic invoices. This platform features modular business components and workflows that can be tailored to meet diverse requirements. Having current and precise tariff and reference data is vital for successful invoice validation. Sumex collects this reference information from publicly available sources, processes it quickly, and provides access through the Sumex tariff server. In addition, this data is presented in a user-friendly information system, enabling professionals to consult it during the invoicing process. The DRG Expert tool improves the management of billing for acute care services, ensuring compliance with SwissDRG standards. It not only organizes case data according to these regulations but also incorporates key statistical measures and allows for scenario analysis to enhance decision-making. By adopting this thorough methodology, all parties involved are equipped with essential resources to uphold precision and efficiency in their billing operations, fostering a more effective financial ecosystem.

What is Context 4 Health Plans Suite?

Ensure the dependability of your health plan while identifying precise pricing through the Context4 Health Plans Suite, our adaptable and cloud-based technological solution. Gain immediate and actionable insights for identifying Fraud, Waste, and Abuse (FWA), crafted by our team of certified experts proficient in clinical, dental, and health benefits. By utilizing reliable data along with cutting-edge cloud technology, we provide a strong and justifiable Medicare reference-based pricing (RBP) solution. Our platform integrates over 100 healthcare data sets, further enhanced by expert guidance to improve operational efficiency and maintain regulatory compliance. Moreover, our advanced medical coding software is designed to facilitate claim submissions and minimize the chances of denials. In addition, our cloud-based Payment Integrity Platform employs a distinctive analytics engine to detect coding errors, evaluate medical necessity, tackle unbundling, and identify fraud, waste, and abuse, while also assessing audit risks and uncovering pricing inconsistencies that could greatly impact your organization’s overall performance. This all-encompassing strategy not only protects your financial stability but also equips you for lasting success in the dynamic healthcare environment. With our commitment to innovation, you can navigate challenges with confidence and ensure a future of continued growth.

Media

Media

Integrations Supported

Siddhartha
Virtual Benefits Administrator (VBA)

Integrations Supported

Siddhartha
Virtual Benefits Administrator (VBA)

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

Sumex

Date Founded

2019

Company Website

www.sumex.ch/en/Sumex-Suite

Company Facts

Organization Name

Context4 Healthcare

Date Founded

1988

Company Location

United States

Company Website

www.context4healthcare.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

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

Insurance Claims Management

CRM
Claims tracking
Customer portal
Document management
EDI data exchange integrations
Electronic claims
Fraud management
Reporting

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