Service Center
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.
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Cloud Claims
APP Tech has been at the forefront of implementing an incident-based methodology in claims and risk management since its inception in 2003, providing advanced technological solutions to a wide array of clients throughout North America. Our integrated systems have enhanced efficiency and scalability in claims management, improved visibility, accelerated response times, reduced premium costs, and mitigated risk events for numerous customers.
Cloud Claims by APP Tech stands out as an acclaimed software solution for risk management and claims processing. Designed specifically for self-insured organizations, third-party administrators, and businesses aiming to monitor their claims and losses, IMS facilitates comprehensive management of the claim lifecycle—from the initial incident report to payment processing and collections. The platform boasts a rich assortment of features that empower users with full oversight of both their claims and associated risk data, including incident and claims management, collaborative tools, detailed reporting, and insurance tracking, among many others.
We take great pride in our flawless implementation success and outstanding customer retention rates, which stem from our dedication to thoroughly understanding our clients’ unique demands and delivering tailored solutions that effectively address those needs. Furthermore, our ongoing support ensures that clients maximize the benefits of our software long after implementation.
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Virtual Examiner
The Virtual Examiner®, developed by PCG Software, serves as a comprehensive tool for overseeing an organization’s internal claims process, efficiently tracking provider data to identify fraudulent or abusive billing practices while enhancing financial recovery. This advanced software enables healthcare organizations to optimize their claims adjudication systems, processing over 31 million edits per claim, which significantly streamlines operations. By meticulously monitoring the internal claims processes, it effectively pinpoints and mitigates payments made for incorrect or erroneous codes, ultimately preserving premium dollars. Beyond mere claims management, the Virtual Examiner® acts as a robust cost containment solution that analyzes claims for not only abusive billing patterns but also those that may require attention to third-party liability coordination, case management opportunities, physician billing education, and various other valuable cost recovery insights. Its multifaceted approach provides healthcare organizations with the tools they need to navigate complex billing landscapes and improve overall financial health.
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Five Sigma
Five Sigma has set out on a mission to enable claims organizations to adopt innovative solutions. Their array of claims management tools and unique platform provides insurers with the resources needed to adjust their claims processes in a rapidly changing landscape. With a comprehensive selection of Claims-First Cloud-Native and User-Centric products, Five Sigma empowers adjusters to handle claims with greater efficiency and speed. By automating repetitive administrative tasks, adjusters are able to focus on making well-informed decisions, while the system adeptly takes care of the remaining operations. The introduction of Clive™ by Five Sigma marks a significant advancement in the industry, as it is the first AI-driven claims adjuster designed to transform how insurers, MGAs, and TPAs process claims. Utilizing advanced AI and automation technology, Clive enhances the entire claims lifecycle, starting from the First Notice of Loss (FNOL) right through to the final settlement. This intelligent agent not only increases the efficiency of claims management but also enhances precision and minimizes expenses by automating a range of tasks, ultimately creating a more seamless and effective process for all parties involved. Furthermore, Five Sigma’s commitment to innovation is paving the way for a new era in claims management that promises to benefit the entire industry.
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