skip to Main Content
Technical Services

Diminish Risk, Improve Efficiency and Expand Provider Accessibility

Our technical services are supported by our HxPro Platform. Our innovation and flexible core administrative capabilities can be a part of your long-term plan and help you build upon your competitive advantage and bring your future strategies to fruition.

With exceptional expertise in claims processing, designed to achieve cost-effective clinical, financial, and operational outcomes, we can help you optimize your processes and place the focus where it needs to be on your members/member care.

Claims Administration

Successfully administer plans across multiple lines of business. Achieve greater levels of operational efficiency and plan for future needs with a dynamic and flexible claims administration system. Our easily configurable, cloud-based claims processing and adjudication solutions for commercial, Medicare, and Medicaid markets reduce the cost of technology ownership and allow for rapid implementations.

On average, we process 98.5% of claims within 30 days, financial accuracy at 99%, and statistical accuracy at 100%.

We integrate numerous claims formats with ease. You can specify parameters or rules according to CMS processing guidelines, payment methodology, and individual health plans. You can also accurately process, pay, and store claims and claims payment remittance advice/EOPs/EOBs. Our solutions allow you to: Lower administrative costs to better meet the medical loss ratio and other regulatory requirements.

  • Increase the accuracy of your claims adjudication rates
  • Integrate claims edit and re-bundling
  • Manage complex benefit and reimbursement methodologies
  • Complete HIPAA compliant transactions
  • Eliminate paper workflow
  • Batch claim re-processing for specific providers, contracts and various bulk criteria
  • Configure fuzzy logic such as check duplications and authorization matching
  • Print Claim and Capitation checks
  • Improve claim queues and workflows

IS Reporting

Stop spending valuable time configuring metrics and quickly create reports to fit your business needs. Our rapid flow of information and reporting capabilities are unmatched by our competitors. Knowing data is the most critical component of reporting. A full data set is always available, and with our out-of-the-box reporting features, users can pull reports based on their chosen criteria. Our team takes every precaution to protect your data. You will receive an exclusive server(s) and a secure TP site that allows secure segregation of data and safeguards data to the highest security level.

Our systems report on HEDIS, CAHPS, STARS, HOS, RAPS, and EDPS. If your team needs additional reports, they can add them as part of the application. Our on-site senior compliance officer monitors CMS requirements for clients and facilitates any updates to the system. Our package includes a comprehensive logging capability that tracks all user activity throughout the system.

The following are a few samples of our pre-configured reports:

  • Claims Audit Summary Report
  • Finance & Payment Check Run Statistics
  • Enrollment Part D Report

Portal Solutions

Give members and providers more control, collaboration, and the tools to be involved with your organization. Our portals consist of a provider portal, a member enrollment portal, a broker portal, and a care management portal.

HealthAxis’ portals can be seamlessly integrated into your core administrative systems through our open API, giving you the tools to involve all stakeholders within your organization.

Our portals offer:

  • Simple, Easy-to-use Interfaces
  • Provider Director
  • Appeals & Grievances
  • Document Management Solutions
  • Regulatory Memo Tracking
  • HR Tracker
  • PR Activity System
  • Provider Training System

System Configuration

Take the risk and variability out of your project. We are committed to knowing your business by closely examining and optimizing a combination of people, processes, and technology. By working closely with your team, we guarantee the proper execution of your configuration and implementation.

To accommodate your growing and changing requirements, we assist in developing and maintaining tactical and strategic plans for your data center – capacity planning for all aspects of the environment, benchmarking, and reporting.

Our team of experts works with you to:

  • Ensure successful setup and continuous maintenance
  • Setup a full configuration of plans, products, and networks
  • Manage and maintain software releases and update testing
  • Configure EDI transaction interfaces
  • Enrollment Exception Reports
  • Rollover LEP Report
  • Disenrollment Count Report
1.5+

Lives Served

97%

Customer Retention

40+

Instituting Claims
Software & Services

Back To Top