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What is Venue Claims Management?

Venue â„¢ Claims Management for Independent Adjusters delivers a comprehensive solution for managing the entire workflow of claims processing. This innovative system caters to a diverse range of users, including adjustment firms, third-party administrators, insurance companies, and self-insured entities. Users benefit from a highly adaptable interface that allows for extensive customization of the claims management system to suit their unique requirements. The platform features an integrated web service interface, which enables both real-time and batch data imports, updates, and exports to nearly any external source of claim-related information. Additionally, it ensures smooth integration with policy and billing systems, allowing for the real-time synchronization of crucial policy-related data, including key policy dates and alerts such as ongoing fraud investigations and assumed policies. The system is equipped with robust functionalities for every aspect of claims processing, encompassing claim payments, recovery processes, reserves monitoring, contact management, trust accounts, forms templates, and comprehensive reporting tools. Ultimately, Venue â„¢ empowers organizations to significantly improve their claims management efficiency and overall effectiveness in handling claims. With its extensive capabilities, it stands out as a vital resource for any organization looking to optimize their claims processes.

What is Shift Payment Integrity?

Shift’s Payment Integrity presents a sophisticated AI-enhanced solution specifically designed for health plans, focusing on improving accuracy while reducing costs in the claims payment process. This cutting-edge tool functions effectively in both the pre-payment and post-payment stages, allowing plan administrators to detect potential problems early and recover overpayments with ease. Key features include dynamic claims editing with up-to-date rules, AI-assisted examinations of medical records, identification of anomalies, as well as fraud, waste, and abuse, along with the incorporation of external data for a more thorough analysis. The system is built to adapt to evolving policies and guidelines, featuring automated policy evaluations and an edit logic workbench that permits health plans to test ideas before full implementation. Furthermore, it offers clear flags and alerts that inform reviewers of the reasons behind claim flagging, speeds up document reviews by highlighting crucial sections of records, and uses data mining techniques to reveal emerging patterns. In addition, the platform provides a unified case management interface that optimizes investigative workflows, driving greater operational efficiency for health plans. Ultimately, this innovative solution empowers health plans to navigate the complexities of the claims process more effectively.

Media

Media

Integrations Supported

Additional information not provided

Integrations Supported

Additional information not provided

API Availability

Has API

API Availability

Has API

Pricing Information

$5 per month
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

KLJ Computer Solutions

Date Founded

1995

Company Location

Canada

Company Website

www.venueclaims.com

Company Facts

Organization Name

Shift Technology

Date Founded

2013

Company Location

France

Company Website

www.shift-technology.com/products/payment-integrity

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

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