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HealthAxis’s Core Benefit Admin system offers a mature complement of SaaS-based healthcare benefits software solutions for benefits administration and healthcare claims processing. The system includes benefits enrollment, member management, billing, claims workflow and auto-adjudication allowing access to technology with low ongoing costs and efficient benefit plan administration.


Our system is fully capable of administering all types of health plans including commercial insurance, Medicare, Medicaid, self-funded (TPA or first party payer) plans, IPA’s, and ACO’s. It is fully integrated with ourservices capability and our web portals allowing for the complete integration of member management and claims processing from claims receipt to claims payment.

HealthAxis Determinants

As the healthcare landscape becomes more consumer-centric, organizations must rely on innovative technology in order to remain competitive. The HealthAxis Determinants system provides partners with improved benefit plan implementations, operational efficiencies and adaptability to the rapidly evolving landscape.

A Determinant is an end-user configurable decision point; and is used in some form or another in every module of the HealthAxis system. In a claim line item evaluation scenario, HealthAxis Determinants can be used to do the following:

  • Authorization – used to determine which authorization applies to the claim/line
  • Benefits – used to determine which benefit applies to the line item
  • Contract – used to determine which contract can be used for pricing
  • DOFR – used to determine risk-type
  • Fee Schedule – used to determine if a fee schedule item applies to the line item
  • Membership – used to determine how to handle TRC response codes
  • Pre-Existing – used to determine whether a condition is pre-existing
  • Rider – used to determine which rider may apply
  • Sensitive Services – used to determine which services to consider sensitive
  • Utilization Worklist – used to determine user access/priority within the UM queue
  • Provider Worklist – used to determine user access/priority within the PR queue
  • Claim Worklist – used to determine user access/priority within the claims queue
  • Authorization Worklist – used to determine user access/priority within the authorization queue


  • Complex Benefit Plan Configuration and Reimbursement Methodologies
  • High Auto-Adjudication for Claims Processing
  • Consumer-Driven Health Plans (CDHP/HRA/HSA)
  • Powerful Online, Real-Time Claims Workflow Engine
  • Integrated Medical Claims Editing and Code Bundling
  • Extensive Provider Database Management Administration
  • Data Integration to Vendors and HR Systems
  • Customer Service Call Tracking Module
  • Comprehensive Provider Management Option
  • Fully Integrated Healthcare Information Technology Services
  • Safe, Secure & Redundant Data Storage
  • Continually Upgraded Claims Processing and Admin Software
  • Supports high auto-adjudication rates
  • Comprehensive benefit plan, DOFR and fee schedule configuration options
  • Electronic EDI for Claims, Encounters, EOR, EOB and eligibility request and response; HIPAA 5010 ready
  • Integrated Document Management and BPO Services Available
  • HCC and P4P administration, tracking and reporting


Drives high auto-adjudication rates

Flexible rules-based & programmable benefit plan administration

Manages Consumer Driven Health Plans (CDHP)

Complex data integration to vendors/HR systems

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