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Description
Claims adjudication services cover a range of areas including medical, dental, vision, and prescription claims, as well as short and long-term disability cases. These services can be accessed either on-site with a license or through a hosted application model (ASP). Utilizing Microsoft technology, the system is powered by an SQLServer database paired with a Windows front end. Our customer service is highly regarded, staffed by healthcare claims professionals who boast a minimum of 12 years of industry experience. All support inquiries are recorded, and their statuses can be monitored online. The system features a plan copy and modification tool that facilitates rapid plan implementation. Auto-adjudication is achieved through benefit codes that are constructed using business rules derived from over 25 variables connected to both the claims and the claimants, which are then processed by the adjudication engine. Claims can be submitted in various formats, including scanned images, EDI, or paper submissions. The system is compliant with HIPAA EDI 5010 transaction sets, ensuring secure and efficient processing. Additionally, re-pricing fees and UCR schedules can be pre-loaded into the system prior to their effective dates, while the date-driven logic ensures that re-pricing occurs based on the service date, optimizing the claims processing workflow. The comprehensive nature of this system allows for a more streamlined and efficient claims management experience.
Description
Tyler Technologies offers a Workers' Compensation software solution that streamlines various processes while complying with the intricate rules governing workers' compensation programs. This software empowers agencies to effectively receive, monitor, and manage an array of workers' compensation claims, which encompass work-related injuries and occupational illnesses, thus ensuring that benefits are delivered accurately and in a timely manner. It facilitates the entire claims lifecycle, from the initial intake to adjudication and resolution, and includes features for document management, workflow automation, and comprehensive reporting. Its design aims to boost operational efficiency, lessen administrative burdens, and enhance adherence to regulatory demands. By optimizing case management processes, agencies can prioritize providing high-quality services to claimants while simultaneously upholding the integrity of their programs. Ultimately, this software not only simplifies the management of claims but also contributes to an overall improvement in service delivery and compliance.
API Access
Has API
API Access
Has API
Integrations
No details available.
Integrations
No details available.
Pricing Details
No price information available.
Free Trial
Free Version
Pricing Details
No price information available.
Free Trial
Free Version
Deployment
Web-Based
On-Premises
iPhone App
iPad App
Android App
Windows
Mac
Linux
Chromebook
Deployment
Web-Based
On-Premises
iPhone App
iPad App
Android App
Windows
Mac
Linux
Chromebook
Customer Support
Business Hours
Live Rep (24/7)
Online Support
Customer Support
Business Hours
Live Rep (24/7)
Online Support
Types of Training
Training Docs
Webinars
Live Training (Online)
In Person
Types of Training
Training Docs
Webinars
Live Training (Online)
In Person
Vendor Details
Company Name
Complete Health Systems
Website
completehealthsys.com/claims/
Vendor Details
Company Name
Tyler Technologies
Founded
1966
Country
United States
Website
www.tylertech.com/solutions/health-human-services/disability-benefits/workers-compensation-case-management
Product Features
Claims Processing
Adjustor Management
Case Management
Claim Resolution Tracking
Co-Pay & Deductible Tracking
Compliance Management
Customer Management
Electronic Claims
Forms Management
Paper-Based Claims
Payor Management
Policy Administration
Product Features
HR Compliance
Alerts / Notifications
Certifications Management
Communication Tools
Customizable HR Documents
Document Management
Records Management
Regulations Monitoring
Reporting / Analytics
Roles / Permissions
Version Control
Workflow Management