Top Enterprise Health Solution Alternatives

Office Ally's Service Center is relied upon by over 80,000 healthcare practitioners and service organizations to effectively manage their revenue cycles. The platform offers functionality for verifying patient eligibility and benefits, as well as the ability to submit, amend, and monitor claims statuses online while also facilitating the reception of remittance advice. By supporting standard ANSI formats, data entry, and pipe-delimited formats, Service Center significantly enhances administrative efficiency and optimizes workflows for healthcare providers. Furthermore, this comprehensive tool empowers organizations to focus more on patient care by reducing the time spent on administrative duties.

HealthRules® Payer is a state-of-the-art core administrative processing framework that delivers transformative capabilities for health plans of all shapes and sizes. For more than ten years, health plans that have adopted HealthRules Payer have successfully seized market opportunities and sustained a competitive advantage. What distinguishes HealthRules Payer from other core administrative systems is its unique utilization of the patented HealthRules Language™, which closely resembles English and introduces an innovative approach to configuration, claims management, and transparency of information. This exceptional system empowers health plans to grow, innovate, and excel beyond their competitors more efficiently than any other core solution currently available. Consequently, HealthRules Payer not only enhances operational efficiency but also cultivates a culture of adaptability and responsiveness within health organizations, ultimately leading to improved patient care and satisfaction. By integrating advanced tools and methodologies, HealthRules Payer positions health plans to thrive in an ever-evolving healthcare landscape.

AZZLY Rize stands out as the leading clinical and business platform tailored for organizations focused on addiction treatment and mental health. This innovative technology platform is designed to grow alongside your needs, allowing you to utilize a variety of features according to the specific requirements of your program and staff. For OUTPATIENT Programs, essential features include e-check-in, scheduling, appointment reminders, Zoom telehealth, treatment plans, progress notes, assessments, and surveys, while RESIDENTIAL Programs benefit from functionalities like census management, medication oversight, bed board tracking, withdrawal management, DrFirst e-prescribing, EPCS, PDMP integration, and laboratory services. Across all types of programs, users can rely on alerts, robust patient engagement tools, exceptional implementation and support services, and efficient electronic billing and claims submission. As a comprehensive all-in-one solution, AZZLY Rize empowers treatment centers to enhance their compliance, manage revenue cycles effectively, and meet reporting obligations with ease. This platform is specifically designed for mental health and substance use disorder initiatives, enabling organizations to adopt a flexible pricing model that replaces outdated technology seamlessly. Additionally, users can take advantage of our compliant Master Library of Forms, or we can customize your documentation forms to align with your current practices. With the added security of being hosted on the Microsoft Azure Private Cloud Network, we ensure HIPAA privacy standards are upheld throughout all operations. Ultimately, AZZLY Rize not only streamlines processes but also significantly enhances the overall efficiency of treatment centers.

Evolent Care Partners, a healthcare provider based in the Midwest, has achieved notable progress in both clinical and administrative performance, securing the impressive position of third nationally for total shared savings and the percentage of savings relative to benchmarks. By equipping independent primary care physicians with vital resources and capital, Evolent Care Partners enables them to successfully navigate and flourish under two-sided payer contracts, thus reducing their financial risks. In the realm of oncology and cardiology, New Century Health improves cost-effectiveness and care quality by utilizing clinical evidence to guide treatment decisions, an approach that garners support from both payers and providers. Additionally, Evolent Health Services enhances the efficiency of health plan operations with a comprehensive suite of services built on a modern, integrated platform and a commitment to strategic partnership. The organization also promotes the exploration of insights and updates related to value-based care, population health, and health plan management, reflecting its dedication to healthcare transformation. Overall, through these collective efforts, Evolent aspires to create a more streamlined and effective healthcare environment for all stakeholders involved.

I-CAPS, which stands for Intelligent Claims Administration System, is a comprehensive solution tailored to address all elements of the health claims payment landscape through a cohesive structure that caters to the varied needs of payers. This includes essential functionalities such as membership management, billing, enrollment, mailroom operations, claims processing, network oversight, contracting, pricing strategies, utilization reviews, and customer support. Our I-CAPS system, combined with the Advanced Value Scale (AVS) coding compliance software, empowers clients to make well-informed decisions, aiding them in effectively managing costs. Additionally, the Advanced Network Administrator (ANA) streamlines the accuracy of provider information with high efficiency. Our innovative Resource-Based, Usual Customary, and RESPONSIBLE fee schedule (RB-UCR), grounded in RBRVS and NCCI frameworks, stands out as a market leader. To thoroughly evaluate your plan or provider’s performance, we recommend our Cost Containment Audit and Recovery Services (CCARS), which deliver a careful and non-disruptive analysis of claims efficiency. This comprehensive strategy not only boosts operational performance but also fosters increased transparency in the health claims sector, ultimately benefiting all stakeholders involved. By implementing our solutions, organizations can significantly improve their overall claims management processes while enhancing service delivery.

PlanXpand™ is a cutting-edge transaction processing engine crafted by Acero, designed to support all products tailored for health benefits administrators. This innovative system empowers clients to adopt Acero’s solutions either in full or incrementally, providing them with the versatility to fit their unique operational needs. In addition to choosing from a comprehensive selection of standard products, administrators are encouraged to leverage PlanXpand™ to develop customized solutions that enhance their existing system functionalities. Acero stands out with its distinctive, integrated offerings that utilize a Service-Oriented Architecture, allowing health benefits administrators and insurers to seamlessly expand their current adjudication platforms with added features and capabilities. The sophisticated design and engineering behind our solutions enable real-time adjudication for all types of claims, which directly interfaces with the core claims system, enhancing processing accuracy, boosting customer satisfaction, and minimizing the need for claims adjustments. This remarkable adaptability and meticulous precision in claims processing not only enhances operational efficiency but also reinforces Acero’s position as a frontrunner in the health benefits administration industry. Ultimately, our commitment to innovation ensures that clients can navigate the complexities of health benefits management with confidence and ease.

HEALTHsuite offers an all-encompassing benefit management system along with claims processing software tailored for health plans that oversee Medicare Advantage and Medicaid benefits. As a rules-driven auto adjudication solution, HEALTHsuite streamlines every facet of enrollment and eligibility, benefit management, provider contracting and reimbursement, premium billing, care coordination, claim adjudication, customer service, and reporting, among other functions. By integrating these processes, HEALTHsuite enhances efficiency and accuracy for health plan administrators. This comprehensive approach ensures that all stakeholders can manage their responsibilities with greater ease and precision.

IMPACT stands as the foundation of our extensive healthcare administration software suite, meticulously crafted to streamline all facets of healthcare data transactions. Users depend on IMPACT for a variety of essential functions, including enrollment handling, provider contract management, benefit plan oversight, and the navigation of authorizations and referrals, along with claims processing and the intricacies involved in these operations. With a remarkable degree of adaptability, IMPACT is furnished with a wide array of features specifically designed for the healthcare sector. The positive feedback and gratitude from our clients provide us with immense satisfaction, underscoring the significance of our collaborative efforts and the software that enhances their professional journeys. At MCSI, we believe that technology must center on customer needs; thus, we are committed to creating solutions that effortlessly adapt to our clients' enterprises, empowering them to flourish in their respective markets. Our extensive experience spans all aspects of healthcare data management and solution deployment, and we take pride in developing software that prioritizes automation, accuracy, and reliability, ensuring our clients can navigate the ever-changing landscape with confidence. Consequently, our dedication to innovation and excellence propels us to consistently refine our offerings, ensuring they meet the evolving needs of the healthcare industry while fostering long-term partnerships with our users. By continually engaging with our clients, we strive to anticipate their future requirements and integrate their feedback into our development process.

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.

Elevate your claims management approach while minimizing denials through exceptional edits and an outstanding clean claim rate. Healthcare providers must leverage cutting-edge technology to guarantee accurate claim submissions and prompt payments. Claims Director, the innovative claims management platform offered by SSI, streamlines billing processes and enhances transparency by guiding users through the entire electronic claim submission and reconciliation experience. As reimbursement standards from payers evolve, the system diligently monitors these adjustments and modifies its operations accordingly. Additionally, with a wide range of edits at industry, payer, and provider levels, this solution enables organizations to optimize their reimbursement strategies efficiently. By embracing such a robust tool, healthcare systems can witness a remarkable improvement in their financial performance, ensuring sustainability and growth in an increasingly competitive landscape.

HealthAxis delivers comprehensive solutions tailored for payers, providers, and healthcare organizations. Our offerings encompass a sophisticated claims processing system, third-party administrator (TPA) services, and insightful analytics to drive meaningful results. By streamlining operational processes, we enhance both patient experiences and client satisfaction. While the healthcare landscape is increasingly embracing technological advancements, it still faces challenges linked to outdated systems, coordination difficulties, and information management hurdles. Our mission is to introduce innovative strategies to those grappling with these obstacles. We view our clients as full business partners, firmly believing that our achievements are interconnected with their ongoing success and development. By empowering our partners, we enable them to deliver greater value to the communities they serve, fostering growth in membership and broadening their operational reach. Each member of our team understands their crucial role in supporting our partners to unlock their full potential, ensuring a collaborative journey toward excellence in healthcare delivery.

Enter revolutionizes the payment process for healthcare providers, ensuring they receive reimbursements faster than any other company in history. By processing insurance claims and disbursing payments within a mere 24 hours, Enter enhances efficiency and streamlines communication with patients regarding their financial responsibilities through an advanced white-label collection system that accommodates payment plans. This innovative approach makes Enter 30 times more effective at securing claim payments and 45 times faster at billing patients, all while maintaining costs comparable to traditional medical billing services. Over the course of a single year, Enter successfully managed over $150 million in claims, demonstrating its impactful presence in the healthcare financial landscape. Additionally, providers have the advantage of accessing a substantial $100 million credit facility, further supporting their operational needs. Partnered with United Healthcare Nevada for revenue cycle management, Enter caters to a diverse array of specialties, including Ambulatory Surgery Centers (ASC), Orthopedics, Neurology, Dermatology, Emergency Rooms, Behavioral Healthcare, Pain Management, and many others. The company collaborates seamlessly with all government and commercial health insurance carriers and ensures compatibility with all EMR and practice management systems, eliminating both monthly and integration fees. Backed by venture funding, Enter is poised for continued growth and innovation in the healthcare industry.

PayorLink solutions offer a comprehensive platform that transcends basic medical claims management for employers, with the goal of improving employee benefits while reducing healthcare costs, promoting healthy habits, and enhancing overall workforce productivity. The rising expenses associated with employee healthcare present a significant challenge worldwide, prompting concerns from both payor organizations and healthcare providers. Tailored specifically to minimize health-related spending for payors, PayorLink™ encourages higher employee productivity and enhances the quality of claims submitted by providers through efficient information sharing between payor entities and their partner healthcare facilities, including clinics, hospitals, and medical centers. Furthermore, it features tools for creating Employee Health Profiles and conducting Assessments, which are instrumental in achieving staff wellness and productivity. By prioritizing these key areas, PayorLink not only tackles pressing financial issues but also cultivates a more vibrant and health-conscious workplace, ultimately contributing to a more sustainable healthcare ecosystem. This holistic approach to employee health represents a significant advancement in how organizations manage and optimize their healthcare resources.

At the point-of-care, processes for authorization, claim processing, and payment are efficiently integrated. By enhancing care coordination, we aim to achieve improved health outcomes while reducing medical expenses and simplifying administrative workflows. Engaging providers directly at the point of care allows for immediate data sharing and collection, facilitating an unparalleled flow of health information. Our collaboration with clients focuses on developing risk management strategies that lead to superior outcomes at reduced costs. We strive to enhance the experience for all participants within the healthcare ecosystem. To maximize the effectiveness of our clients' resources, we ensure a minimum return on investment of 3:1. Conexia has developed a versatile core technology platform known as ONE, which can be tailored to align with the varying regulatory needs and operational workflows of each client in different regions. Typically, our initial implementation serves as an enhancement to the existing technology framework of payers, enabling real-time operational capabilities that significantly improve efficiency. Ultimately, our goal is to create a seamless integration that benefits all stakeholders involved in the healthcare process.

USSI proudly presents its extensive collection of professional insurance software solutions, designed as an all-in-one administration package. These comprehensive offerings aim to ensure that your insurance agency operates at optimal efficiency within a fast-paced and competitive environment. The InsurancePlus Individual Life and Health Administration software effectively manages business portfolios for both conventional and cutting-edge Life and Health insurance providers, accommodating various product lines such as Whole Life, Term Life, Interest Sensitive policies, Final Expense plans, Annuities, and Supplemental Health insurance. Furthermore, USSI's InsurancePlus Group Life and Health Administration software adeptly handles portfolios for Group Health insurance companies, Self-Insured Funds, and Third-Party Administrators (TPAs), catering to a broad spectrum of plan options including Point of Service, Major Medical, Term Life, High Deductible, and Traditional Indemnity plans. With a plethora of features at their disposal, USSI guarantees that their software solutions are not only versatile but also tailored to address the specific requirements of each client in the insurance industry. This commitment to adaptability positions USSI as a leader in providing innovative insurance technology solutions.

EbixEnterprise operates as a comprehensive solution for managing insurance, streamlining policy management across its entire life cycle. The platform includes six essential components: Customer Relationship Management (CRM), a health insurance exchange, policy administration, claims administration, data analytics, and a consumer web portal. These interconnected elements ensure that data flows smoothly to meet various business needs. SmartOffice CRM allows organizations to effectively manage details about agents and brokers, commission systems, sales processes, and state licensing information. Additionally, the Online Quoting Portal, known as HealthConnect, serves as an exceptional marketplace for the trading of health insurance and employee benefits. Moreover, EbixEnterprise Administration provides a powerful policy management system, supplying users with the essential tools to oversee policies, outline insurance plans, and keep track of relevant rate information. This all-encompassing strategy not only boosts operational efficiency but also fosters enhanced decision-making throughout the organization. Ultimately, EbixEnterprise positions itself as a pivotal asset for businesses looking to optimize their insurance management practices.

SpyGlass, our cutting-edge software designed for enterprise-level health claims management, offers a flexible and powerful solution for achieving precise and efficient claims processing. This platform greatly simplifies the configuration of benefits and plans. Complementing SpyGlass, BenefitDriven provides specialized features such as eligibility verification, contribution accounting, and pension management tailored specifically for the Taft-Hartley sector, which includes a thorough array of data and processes for both Participants and Employers. Our comprehensive EDI gateway and scheduler, known as HIPAA Director, serves as a pivotal hub, facilitating effortless connections with vendor partners to reduce transaction costs, optimize batch transfers, and automate the entire transfer process. With SpyGlass, you not only gain a broad overview of your population but also have the ability to easily access detailed information. The platform offers a vast array of customizable reports and dashboards, allowing you to maintain complete control over your system, ensuring that all the necessary tools for informed decision-making and operational optimization are readily available. Ultimately, SpyGlass empowers organizations to significantly boost their efficiency and effectiveness in managing health claims while adapting to the evolving needs of the industry. Through its innovative features and user-friendly interface, SpyGlass stands out as the ideal choice for organizations seeking to streamline their health claims processes.

ResolvMD is an experienced, comprehensive medical billing company that manages a variety of health service claims, including AHCIP, for healthcare providers. We aim to equip physicians with the confidence and knowledge necessary to excel in their billing processes, paralleling their medical competence, by offering valuable data insights and easily accessible information. Our platform stands out as the most innovative, budget-friendly, and secure option for claims processing in the market. Our principal clientele includes doctors, particularly specialists such as emergency room physicians, urgent care practitioners, plastic surgeons, anesthesiologists, pediatricians, and general surgeons, who require a dependable billing partner for their health service claims. These medical professionals prioritize attributes like efficiency, trustworthiness, affordability, and expertise when selecting a billing service. At present, our focus is directed towards physicians in Alberta, specifically targeting urban centers like Calgary, Edmonton, Red Deer, Medicine Hat, and Lethbridge, as well as any regions with populations exceeding 25,000, ensuring we cater to the needs of a vibrant and expanding healthcare network. We strive to support these healthcare professionals in navigating the complexities of medical billing, allowing them to concentrate on providing exceptional patient care.

The FACTS® product suite serves a diverse range of industries through a cohesive information system that encompasses Health, Indemnity, TPA, PPO, HMO, PHO, IPA, MSO, Group Administration, COBRA, Section 125-Integrated Flexible Benefits, and Workers' Compensation with Integrated Managed Care, providing comprehensive coverage around the clock. Since the introduction of HIPAA, the foundational design of the FACTS® system has focused on solutions that comply with HIPAA regulations. With a strong commitment to making the path to HIPAA compliance as smooth and efficient as possible, FACTS® emphasizes preparation well ahead of mandated federal deadlines. The fully integrated and interactive systems offered by FACTS®—which can be accessed through both the Internet and voice—empower healthcare professionals and administrators with 24/7 access to critical claims and benefit information, while also facilitating real-time transactions such as online EDI claim submissions. By leveraging these resources, organizations can greatly improve their risk management and insurance oversight processes. In addition, FACTS® is unwavering in its commitment to ongoing enhancement of its services to better meet the evolving needs of its users, ensuring that they are always equipped with the best tools available. This dedication to improvement underscores the company's mission to provide exceptional support tailored to the challenges faced by its clientele.

The Virtual Benefits Administrator (VBA) is recognized as the leading cloud-based software for managing benefits within the industry. With its wide-ranging capabilities and unparalleled flexibility, VBA allows users to efficiently design and manage a variety of health benefits, such as medical, vision, dental, disability, Medicaid, Medicare, Medicare Supplement, care management, long-term care, health savings accounts (HSAs), flexible spending accounts (FSAs), health reimbursement accounts (HRAs), and COBRA. This broad spectrum of services establishes VBA as a vital resource for organizations aiming to enhance the efficiency of their benefits administration workflows. Furthermore, its user-friendly interface ensures that both administrators and employees can navigate the system with ease.

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.

Curacel's innovative platform, powered by artificial intelligence, enables insurance companies to monitor fraudulent activities and streamline claim processing with efficiency. It simplifies the collection of claims from providers while offering automatic verification capabilities. Through Curacel Detection, insurers can effectively pinpoint and mitigate instances of fraud, waste, and abuse throughout the claims process. By gathering claims from providers, the system actively works to prevent any potential losses due to these issues. Our analysis of the Health Insurance sector revealed that significant value loss often occurs during the claims process, which remains largely manual and vulnerable to various forms of exploitation. The implementation of our AI-enhanced solution significantly minimizes waste, enhances efficiency for insurers, and reveals previously obscured value opportunities. Ravel insurance distinguishes itself by offering on-demand policies that provide coverage for short durations, catering to the needs of policyholders and insured parties alike, both of whom seek prompt and precise claim resolutions. By focusing on speed and accuracy, Ravel ensures a smoother experience for all involved.

Filing claims is often a complex yet vital task that many people, more than 60%, choose to avoid due to its convoluted nature and the significant time it demands. Artivatic has developed a tailored claims platform that addresses the needs of various insurance sectors, allowing companies to provide a seamless digital claims experience, facilitate self-processing, automate assessments, and improve the detection of risks and fraud while also managing claims payments. This innovative platform is designed to meet all your claims-related needs, delivering a fully automated and thorough evaluation process. Whether you're dealing with auto, health, travel, accidental, death, fire, SME, business, or commercial claims, this solution ensures comprehensive coverage. By simplifying the claims mechanism, Artivatic seeks to boost operational efficiency and enhance overall customer satisfaction, paving the way for a more user-friendly experience in the insurance landscape. With such advancements, the future of claims processing looks significantly brighter.

Accelerated claims processing is facilitated by various interfaces that effectively align with your corporate branding. Our digital ecosystem provides access from any location at any time, promoting both convenience and flexibility. The handling of Health and Life claims is optimized through sophisticated systems tailored to meet your unique processing needs. We improve the claims lifecycle to match the influx of incoming claims while also managing and resolving more intricate claims at remarkable speeds. The entire process remains swift and continuous, successfully eliminating any delays associated with claims processing. CLAIMSplus enhances the claims journey by partnering with employers, third-party administrators, and insurers, leveraging robust cloud-based processing technologies. At CLAIMSplus, our goal is to refine operational processes and expedite medical claims through secure, reliable, and efficient electronic claims management solutions. Our innovative technology is ultimately built to address claims in a timely and effective manner. Additionally, feedback from our clients consistently emphasizes that the rapidity of the claims process is paramount in successful claims management, reinforcing our dedication to maintaining high efficiency in all aspects of our service. This commitment not only benefits our clients but also contributes to a better overall experience for claimants.

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.

LexisNexis® MarketView™ delivers medical claims-based insights specifically tailored for healthcare payers, providers, life sciences companies, and health IT organizations across the United States. This innovative platform equips users with actionable intelligence aimed at improving their competitive edge, allowing businesses to discover valuable insights and visualize groundbreaking strategies. Whether you are part of a life sciences organization, a health insurance provider, a healthcare system, or a health IT company, MarketView can significantly refine essential business functions like marketing, sales, strategic planning, physician engagement, outreach, market research, network optimization, talent acquisition, pricing strategies, contracting, and clinical management, among others. To maintain an advantage in the fast-paced market, it is crucial for your organization to access the most pertinent insights possible. However, identifying which areas to prioritize can often be difficult without a clear overall perspective. MarketView effectively tackles this challenge by delivering insights into diverse elements such as referral patterns, strategies for aligning with physicians, the performance of clinically integrated networks, and metrics regarding patient volume, all of which empower organizations to make well-informed decisions. Furthermore, by utilizing these insights, businesses can not only spark innovation but also enhance their operational efficiency significantly, ultimately leading to better patient outcomes and streamlined processes.

The FINEOS Platform is distinguished as the only all-inclusive end-to-end SaaS core product suite available for clients, featuring FINEOS AdminSuite that facilitates the management of processes from quoting to claims, as well as supplementary products like FINEOS Engage to improve digital interactions, and FINEOS Insight which offers sophisticated analytics and reporting functionalities. It is an essential component of a modern digital insurance strategy. By incorporating FINEOS AdminSuite, FINEOS Engage, FINEOS Insight, and its extensive platform capabilities, the FINEOS Platform positions itself as the most advanced singular core insurance solution specifically designed for the Life, Accident, and Health industries. Unlike traditional legacy core systems that adhered to a 'one size fits all' technology paradigm, which has become inadequate for agile enterprises, today's sophisticated consumers, employers, and brokers reap the benefits of innovative SaaS solutions that elevate the standards for insurers' digital endeavors. The former monolithic insurance software systems often focused solely on the complexities of insurance contracts, neglecting the essential need for flexibility and responsiveness in the current rapidly evolving market. By choosing the FINEOS Platform, organizations embrace a forward-thinking strategy that resonates with modern consumer expectations and aligns with ongoing technological progress, ensuring they remain competitive in an ever-changing landscape.

Presenting Maestro Health, an innovative third-party administrator (TPA) dedicated to enhancing employee health and benefits. We partner with employers and their trusted advisors to develop health and benefits solutions that genuinely focus on the well-being of individuals. Our self-funded health plan allows employers to directly manage their members' healthcare expenses, eliminating the need for traditional insurance carriers. This model includes handling claims, creating networks, applying repricing strategies, and taking on the risks linked with their plan design. By selecting self-funded benefits, employers gain the flexibility to customize health plans to address the specific needs of their workforce. Our cutting-edge solutions strive to lower costs while improving health outcomes without sacrificing benefits. At Maestro Health, we are dedicated to streamlining employee health and benefits, making the process clear and easily navigable. This commitment enables employers to prioritize what truly matters—the health and happiness of their employees—while we manage the complexities of health benefits. Ultimately, we believe that a tailored approach to employee health is essential for fostering a productive and satisfied workforce.

Healthcare.gov has streamlined the enrollment process for HealthSherpa, allowing for easier access to Affordable Care Act plans. Our collaboration with a diverse range of stakeholders—including employers, insurers, agents, nonprofits, and consumers—aims to maximize enrollment in these comprehensive health plans that qualify for subsidies. We also enhance the functionality of insurance companies' websites, facilitating the enrollment of individuals into Affordable Care Act options. By providing advanced enrollment technology along with a CRM and communication tools, we empower insurance agents to efficiently connect clients with appropriate plans that meet their needs. Currently, over 40,000 agents utilize our platform to enhance their enrollment efforts. In addition, we equip consumers with decision support tools to guide them in selecting the best plan for their healthcare requirements. With more than 5,000,000 consumers successfully enrolled in coverage, HealthSherpa ensures access to the same plans, pricing, and benefits available through HealthCare.gov, reinforcing our commitment to affordable healthcare access for all. This comprehensive approach not only simplifies enrollment but also supports informed decision-making for individuals navigating their healthcare options.

Jopari ProPay is a sophisticated cloud-based payment processing system tailored for healthcare payers, offering a variety of payment methods including EFT/ERA, virtual cards, and traditional paper checks, as well as a self-service portal for accessing Explanation of Benefits (EOBs) and remittance advice (R) delivery, all while ensuring compliance with 835 transactions for electronic billing. This innovative solution allows healthcare payers to move away from paper-dependent procedures, significantly reducing operational expenses by streamlining payment and remittance processes. By enabling payers to outsource their payment processing responsibilities, Jopari ProPay allows organizations to concentrate on their core business functions more effectively. The platform also offers healthcare providers a diverse array of payment delivery options, allowing them to choose what best meets their needs. Additionally, providers can access the self-service portal to track their EOBs and payment statuses, which enhances their overall experience. Jopari ProPay distinguishes itself as a secure and compliant payment processing choice, earning the confidence of over 50,000 ERISA health plans and fully insured groups, which underscores its dependability within the industry. Furthermore, its intuitive interface and extensive support features are key factors in its increasing popularity among both healthcare payers and providers, making it a valuable asset in the healthcare payment landscape. The platform’s commitment to innovation continues to drive its adoption and success in an ever-evolving market.