The OPTUM™ Claims Editing System, an integrated partner product, is a powerful adjunct to the QNXT™ enterprise core administration system. The Claims Editing System is a transparent open-architecture and rules-based application that provides a commercial and Medicare-compliant KnowledgeBase of edits and utilizes date-sensitive processing to adjudicate both professional and facility claims. The application includes full customization capabilities for software auditing logic as well as data relationships and has disclosure statements embedded in the solution. The results for payers are streamlined claims-processing workflows, reduced reimbursement errors and improved payment integrity.
McKesson’s ClaimCheck® code audit solution is an integrated partner product. The ClaimCheck® - QNXT™ interface enables customers to more accurately reflect their medical policies by creating and applying user-defined customized edits. This capability streamlines and improves auto adjudication and greatly reduces administrative expenses. In addition, ClaimCheck improves workflow as recommendations are cross-walked to QNXT remark codes with configurable audit messages. The long standing relationship, the collaborative development, and a stringent certification process ensures the reliability and quality of the interface prior to each release.
Premier Healthcare Exchange | Stratose | Pay-Plus Solutions | GlobalCare, merged in 2016, creating a healthcare information technology company that is a market-leading provider of comprehensive healthcare claims cost management and payment solutions including network solutions, claims integrity, payments and analytical services for medical, dental and workers’ compensation claims to payer clients, electronic payments and explanation of payments to healthcare providers and provider lookup and medical referral services to patients nationwide.
TriZetto and Evolution1 have partnered to offer consumer-driven healthcare administration and benefits card solutions for payer organizations. Through the partnership, Evolution1's industry-leading consumer-driven healthcare administration system is available to TriZetto's health plan clients using the QNXT™ enterprise core administration system. The partnership agreement includes PayDirect and the innovative Benny® Prepaid Benefits Card which uses patented technology to achieve the highest auto-substantiation rates in the industry. Evolution1 is one of the nation's largest electronic payment, on-premise and cloud computing healthcare solutions that administers reimbursement accounts, including HSAs, HRAs, FSAs, VEBAs, Wellness and Transit Plans – and serves a number of the largest health plan providers and administrators, as well as banks across the nation.
Micro-Dyn Medical Systems, Inc. offerings are integrated partner products. Micro-Dyn specializes in software products for healthcare claim DRG calculation, APC assignment, Medicare reimbursement calculation, data editing, and validation to Medicare specifications. Micro-Dyn’s DRGActive™, APCActive™, and PRICERActive™ software and data editing components integrate seamlessly with QNXT to immediately add data validation, DRG/APC calculation and Medicare reimbursement capability.
Sovos Compliance designs technology solutions to help businesses meet the demands of their unique tax, compliance and reporting obligations. The company enables over 4,000 clients to operate with the confidence to efficiently navigate today's dynamic regulatory environment. Sovos Compliance utilizes a unique ability to turn knowledge into highly functional, scalable software that seamlessly integrates with a wide-array of applications and information technologies used by businesses today. Sovos Compliance gives clients peace of mind by simplifying tax compliance, providing greater control and visibility, and mitigating compliance risk.
Emdeon is the healthcare industry’s leading provider of a complete suite of business process outsourcing services with the ability to deliver print and mail services to your healthcare constituents. Emdeon’s Management solutions, an integrated partner solution, provides cost savings and improved efficiencies for paper payment and remittance documents.
The Phia Group is a provider of services designed to control costs and protect plan assets; including subrogation & overpayment recovery, document drafting, compliance and consultation. The Phia Group’s mission is to reduce the cost of health benefit plans through the use of innovative technologies, legal expertise, and focused, flexible customer service.
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TriZetto provides leading healthcare IT solutions for payers and providers. TriZetto promotes integrated care management by offering comprehensive solutions for care management software, claims management services, network management solutions and more. With solutions for care management, patient-centered medical home (PCMH) solutions, payment bundling and other innovative models, TriZetto is helping reduce the cost, improve the quality of care and transform the healthcare industry.