Complete Benefit Administration Solutions for Faster Claims Processing and Better Accuracy

DataGenix delivers complete benefit administration software that automates claims and eligibility while ensuring compliance and accuracy. Our claims handling software and claims benefits software are designed to streamline complex processes, reduce manual errors, and improve operational efficiency.

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Benefit Administration Software

    • EASE OF USE FOR MINIMAL TRAINING TIME
    • SIMPLIFIED ELIGIBILITY AND CLAIMS PROCESSING
    • ADVANCED CLAIM ADJUDICATION WITH AUTOMATED PROCESSING
    • INSTANT ON-SCREEN REPORTING, WEB REPORTING , WEB DASHBOARDS
    • INTEGRATED PRE-APPROVAL AND PREAUTHORIZATIONS
    • RAPID AND FLEXIBLE BENEFIT PLAN SETUP
    • BUILT IN DOCUMENT IMAGING FOR DOCUMENT ACCESS RELATED TO PROVIDER, GROUP, AND
      INSURED MEMBERS
    • CUSTOMER SERVICE CALL AND CORRESPONDENCE TRACKING INCLUDING ONE TOUCH SMS OR
      EMAIL TO CALLER
    • BRITISH AND AMERICAN DATE SUPPORT
    • REAL-TIME WEB ACCESS PORTAL FOR INSUREDS, PROVIDERS AND GROUPS
    • COMPLETE HIPAA COMPLIANCE AND EDI INTERFACES
    • SUPPORT FOR INTERNATIONAL MARKETS AND CURRENCIES
    • COST EFFECTIVENESS AND A PREDICTABLE ROI
    • OPEN ARCHITECTURE DATABASES FOR ACCESS BY THIRD PARTY APPLICATIONS
    • LATEST SQL 2016/2017 64 BIT AND MS .NET ARCHITECTURE
    • SCALABLE TO MILLIONS OF INSURED MEMBERS
    • MULTI-LEVEL GROUP SECURITY WITH LOGGING OF ALL EVENTS
    • MULTIPLE COMPANY, MULTIPLE DATABASE SUPPORT
    • CLAIMS, PREAUTHORIZATION, AND CUSTOMER SERVICE QUEUES FOR MAXIMUM EFFICIENCY
      AND OPTIMIZED WORKFLOW
    • MULTIPLE CURRENCY SUPPORT
    • SUPPORT FOR NON STANDARD PROVIDER CODES AND FEE SCHEDULES
    • UNATTENDED CLAIMS AUTO ADJUDICATION CAPABILITY
    • AUTOMATED WEB AD-HOC REPORTING SYSTEM
    • REALTIME DASHBOARD WEB CHARTS AND GRAPHS
    • SUPPORT FOR CUSTOM AND USER DEFINED FIELDS
    • BUILT -IN ELECTRONIC PRE-AUTHORIZATIONS AND SCANNED CLAIMS SUPPORT
    • INTEGRATED PRE-APPROVAL & CASE MANAGEMENT WORKFLOW
    • RAPID PREAUTHORIZATION QUEUE PROCESSING FROM ELECTRONIC OR OTHER LINKS
    • SINGLE SERVER OR CLUSTERED SERVER SUPPORT
    • MOBILE APP FOR ANDROID AND IOS ( Q4 2019)
    • EDI IMPORT AND EXPORT
    • MULTIPLE INSURANCE COMPANIES AND MULTIPLE MASTER GROUPS CAPABILITY
    • CUSTOM FIELDS OPTION ON KEY SCREENS
    • BIOMETRIC CAPABILITY FOR MEMBER ENROLLMENT AND PROVIDER CLAIMS

    • Broker Commission Management
    • Broker Payments and Statements
    • Broker Notes and Correspondence Tracking

    • BUILT -IN ELECTRONIC PRE-AUTHORIZATIONS AND SCANNED CLAIMS
    • 837 EDI
    • CLAIMS WORKFLOW QUEUE FOR RAPID PROCESSING FROM MULTIPLE SOURCES INCLUDING
      BATCH ENTRY, EDI AND WEB
    • PREAUTHORIZATION WORKFLOW QUEUE FOR RAPID PROCESSING OF PRE-AUTHORIZATIONS
      RECEIVED FROM MULTIPLE SOURCES
    • ADVANCED CLAIM ADJUDICATION WITH ELECTRONIC PROCESSING
    • QUICK ACCESS TO CLAIMS HISTORY
    • UNATTENDED CLAIMS AUTO ADJUDICATION CAPABILITY
    • INTEGRATED PRE-APPROVAL & CASE MANAGEMENT WORKFLOW
    • ELECTRONIC CLAIMS QUEUE PROCESSING FROM ELECTRONIC LINKS OR IMPORT FILES SUCH
      AS 837 OR CSV
    • RAPID AND FLEXIBLE BENEFIT PLAN SETUP
    • REAL TIME INTERFACE WITH CONTEXT WITH HEALTHCARE FIRST PASS SYSTEM FOR
      AUTOMATED CLAIMS ANALYSIS OF PROPER PAYMENT FROM PROVIDER WITH RULES DATABASE
      OF 3.5 MILLION RULES
    • FLEXIBLE AUDIT PROCESSING OF ALL CLAIMS BY EXAMINER, AMOUNT PAID, PROCEDURE
      CODE OR DIAGNOSTIC CODE
    • RAPID PREAUTHORIZATION QUEUE PROCESSING FROM ELECTRONIC OR OTHER LINKS
    • SUPPORT FOR MULTIPLE PROVIDER NETWORKS AND NETWORK RANKING
    • ALL USER CLAIMS MESSAGES INTO SINGLE WINDOW TO ALLOW QUICKER CLAIMS ENTRY AND
      REQUIRE USER TO VIEW ONE WINDOW INSTEAD OF SEVERAL WHILE PROCESSING CLAIM
    • SIMPLIFIED SERVICE CODES SYSTEM FOR EASY TO UNDERSTAND BENEFITS PROCESSING
    • FULL SUPPORT FOR NON STANDARD AND CUSTOM HOSPITAL AND CLINIC CODING
    • BRITISH AND AMERICAN DATE SUPPORT
    • FULL DENTAL CLAIM SUPPORT AND VISUAL TOOTH CHART
    • BENEFITS LIMITATIONS BY PROCEDURE CODE, CATEGORIES, AND TYPES OF SERVICES
    • BENEFIT LIMITATIONS BY AGE, GENDER, DIAGNOSTIC CODE
    • BUILT -IN SUPPORT FOR ELECTRONIC PRE-AUTHORIZATIONS AND SCANNED CLAIMS
    • INTEGRATED ACCESS TO ORIGINAL CLAIMS IMAGE AND ATTACHMENTS
    • AUTOMATED PROCESSING OF BENEFIT PLANS FOR BENEFITS LIMITATIONS AND PROVIDER
      FEE SCHEDULES
    • INSTANT EOBS AND QUICK SUMMARY REPORTS
    • QUICK ACCESS TO PROVIDER FEE SCHEDULES
    • CHOOSE FROM MULTIPLE VARIATIONS OF PAYMENT METHODS
    • FEE SCHEDULE HOT KEY TO VERIFY RATES
    • ONE CLICK ACCESS TO ALL CLAIMS SUBMITTED BY PROVIDER
    • PRE-AUTHORIZATIONS AND REFERRALS DIRECTLY LINKED TO CLAIMS
    • STREAMLINED PRE-AUTHORIZATION PROCESSING QUEUE
    • RECEIVE PRE-APPROVALS BY FAX, SCAN, OR ELECTRONICALLY
    • DETAILED SYMPTOM AND DAILY LEVEL OF CARE TRACKING
    • TRACK REFERRALS, PRE-AUTHORIZATIONS AND COMPLETE HOSPITAL STAYS
    • CLAIMS RECEIVED REGISTER TO TRACK CLAIMS ALL CLAIMS RECEIVED VERSUS CLAIMS
      ENTERED OR PROCESSED
    • PREAUTHORIZATION SUBMISSION FROM INTERNET B
    • TRACKING OF COMPLETE PREVIOUS MEDICAL HISTORY OR PRE-EXISTING CONDITIONS
    • REAL TIME AND BATCH SUPPORT FOR REDCARD, ZELIS PAYMENTS AND CONTEXT FOR
      HEALTHCARE INTERFACES
    • ENTRY OF CLAIMS BY BATCH ENTRY, MANUAL, ELECTRONIC QUEUE OR EDI FILES
    • AUTOMATED CLAIMS ANALYSIS OF PROPER PAYMENT FROM PROVIDER WITH RULES DATABASE
      OF 3.5 MILLION RULES (CPT CODES) (DATABASE RULES PROVIDED BY CONTEXT FOR
      HEALTHCARE)
    • AUTOMATED CLAIMS AND DOCUMENT SCANNING
    • FULL SUPPORT FOR NON-STANDARD AND CUSTOM HOSPITAL AND CLINIC CODING
    • ONE TOUCH ACCESS TO ANY DOCUMENT RELATED TO CLAIM OR PREAUTHORIZATION
    • AUTOMATED PROCESS FOR CLAIMS AND PRE-APPROVALS ALLOWS HIGH SPEED TURNAROUNDS
    • SPECIAL RISK CLAIMS PROCESSING
    • SUPPORT FOR CLAIMS PAYMENT TO MEMBERS AND PROVIDERS VIA NACHA BANK EFT FILE

    • BUILD AD HOC, INSTANT REPORTS IN MINUTES
    • ADVANCED DASHBOARDS WITH CHARTS, GRAPHS AND GRIDS COMBINED
    • Instant On-Screen Reporting
    • Instant EOBs and Quick Summary Reports
    • Export to PDF, Word or Excel
    • Wizard Style Parameter Selection for All Reports
    • Dozens of Sub Reports and Sorting Options
    • Benefits Report by Service Code, Procedure Code, Disease Type
    • Employee Census by Subtotals by Benefits, by Location, by Nationality
    • Book of Business Group Summary
    • Claims Summary by Insured Member
    • Claims Summary by Provider including Top Ten Provider
    • Claims Summary by Amounts Paid Thresholds
    • Hospital Inpatient Stays Summary
    • Claims Detail Reports with Provider, Benefit, Reason Code filters
    • Claims Processing Production Report by Examiner, By Hour, By Group
    • Phone Call Tracking reports by Hour, by Customer Service Representative, by
      Call Category
    • Follow Up/Reminder Reports
    • Inpatient Hospital Stay Census Report
    • Claims Paid by Month During Policy Period Report
    • Claims Paid Turnaround Report
    • Claims Cost Per Member Report for Premium and Paid Claims
    • PENDING CLAIMS REPORT
    • Account Receivable Insured and Group Reports
    • BILLING SUMMARY REPORT FOR INSURED AND GROUP BILLINGS
    • ELIGIBILITY STATUS CHANGES REPORT
    • HOSPITAL UTILIZATION REPORT
    • AVERAGE PAID BY AGE BAND REPORT
    • CLAIMS LAG/IBNR REPORT
    • SECURITY LOGGING REPORTS
    • PREMIUM AND ACCOUNTING REPORTS
    • UNLIMITED AD HOC REPORTS CREATION THROUGH WEB REPORTS SYSTEM
    • REAL-TIME DASHBOARD REPORTS THROUGH TPA DASHBOARD SYSTEM
    • AUTOMATED EMAILING AND SCHEDULING OF ANY REPORT
    • TRIGGERS AND AUTOMATED NOTIFICATIONS
    • CLAIMS INVENTORY REPORT

    • BUILT IN DOCUMENT IMAGING FOR DOCUMENT ACCESS TO PROVIDER, GROUP, AND INSURED
      RELATED DOCUMENTS
    • RAPID SEARCHING FOR INSURED, CLAIM, PREAUTHORIZATION AND PROVIDER INFORMATION
    • CUSTOMER SERVICE CALL AND CORRESPONDENCE
    • SMS OR EMAIL TO RESPONSES TO CALLERS
    • ON-SCREEN PHONE LOG AND CUSTOMER SERVICE QUEUE
    • ROUTE TO SUPERVISOR CAPABILITY
    • ADVANCED CORRESPONDENCE LOGGING WITH ONE CLICK LINKS TO ORIGINAL DOCUMENT
    • INSTANT LINKS TO WORD, EXCEL AND OUTLOOK WITH AUTO FILL LETTERS AND
      CORRESPONDENCE
    • AUTO GENERATED LETTERS WITH MICROSOFT WORD INTEGRATION AND REDCARD SUPPORT
    • ONE TOUCH ACCESS TO PLAN DOCS, CLAIMS AND ORIGINAL PATIENT RECORDS
    • SIMULTANEOUS ACCESS TO MULTIPLE PATIENT SCREENS
    • HANDY CORRESPONDENCE TRACKING AND POP UP NOTES AND REMINDER SYSTEM
    • STREAMLINED CUSTOMER SERVICING WITH MULTI WINDOW SUPPORT
    • UTILIZATION REVIEW AND CASE MANAGEMENT

    • Check and Voucher Printing on MICR Printers
    • SUPPORT FOR PRINTED CHECK OR ELECTRONIC FULFILLMENT THROUGH REDCARD
    • SUPPORT FOR ZELIS E-PAYMENTS
    • Voucher Reporting
    • Multiple EOB Formats
    • Cash Claims Support
    • One Check per Claim or Voucher per Provider
    • PRINTED CHECKS OR ELECTRONIC FULFILLMENT THROUGH REDCARD
    • Multiple Payee and Payer Profiles Insured, Group, Provider, Sub Location or
      User Defined
    • 835 EDI Export
    • CHECK RECONCILIATION AND POSITIVE PAY SUPPORT
    • Payment Check or Export to Third Party Companies like RedCard Systems

    • SINGLE SCREEN ACCESS TO ALL INSURED AND ELIGIBILITY RELATED FUNCTIONS
    • IMPORT ELIGIBILITY RAPIDLY FROM STANDARD FORMATS OR SPREADSHEETS
    • SUPPORT FOR SEPARATE ELIGIBILITY HISTORY AND BENEFIT PLAN FOR ALL MEMBERS OF
      FAMILY
    • SEPARATE ADDRESS CAPABILITY FOR SPOUSE AND DEPENDENTS
    • BUILT IN ID CARD DESIGN AND PRINTING USING MICROSOFT WORD
    • PHOTO CAPABILITY FOR ID CARDS
    • ATTACH ANY EXISTING OR SCANNED DOCUMENT TO INSURED FILE
    • SEPARATE PRIMARY CARE PHYSICIAN HISTORY FOR ALL MEMBER OF FAMILY
    • 834 EDI EXPORT AND IMPORT
    • EXCEL EXPORT AND IMPORT
    • AUTO GENERATION OF MEMBER ID AND SUBSCRIBER ID OPTIONS

    • Red Card – EOBS, Checks, and Letters Fulfillment
    • Context for Health Care – REALTIME Unbundling and Fraud Control AND EDITS
    • Zelis – E-payments to Providers
    • Authorize.Net Credit Card and ACH

    • COMPLETE PREMIUM INVOICING
    • TRACKS RETRO ADDS AND RETRO TERMS WITH AUTOMATIC ADJUSTMENTS
    • RATES BY GROUP, BY BENEFIT PLAN, MEMBER RELATION, AGE, AREA AND OTHER FACTORS
    • MONTHLY PREMIUM INVOICE TO MEMBER OR GROUP
    • SUPPORT FOR PPOS AND TPA/ADMINISTRATION FEES
    • BROKER AND COMMISSION PAYABLES
    • SUPPORT FOR MEMBER CREDIT CARD AND BANK CHECK PAYMENT
    • CREDIT CARD AND ACH SUPPORT
    • ANNUALIZED PREMIUM REPORT WITH PRORATION

    • Group Correspondence Tracking
    • Policy Management
    • Notes and Reminders Follow Tracking
    • Phone Call Inquiries
    • Group Mailing or Faxes to all Members
    • Subgroup/Location Support
    • MASTER GROUP, LINE OF BUSINESS SUPPORT
    • MASS CORRESPONDENCE OR EMAIL SUPPORT TO GROUPS AND MEMBERS
    • Full Document Support to attach Benefits, Contracts and other Documents to
      Group
    • Master Group /Insurance company Grouping and Security

    • COMPLETE PROVIDER CREDENTIAL AND TRAINING HISTORY TRACKED
    • PROVIDER CORRESPONDENCE TRACKING
    • PROVIDER/HOSPITAL RATES AND FEE SCHEDULE MANAGEMENT WITH PROVIDER OR CUSTOM CODES
    • UNLIMITED NUMBER OF HOSPITAL CONTACTS MAINTAINED
    • FEE SCHEDULE SUPPORT FOR FLAT SUPPORT, PERCENTAGE FEES, AND PERCENTILE SYSTEMS SUPPORT
    • NON-STANDARD CODING SYSTEMS SUPPORTED AS WELL AS CPT, ICD9, ICD10
    • PROVIDER MASS MAILING AND CORRESPONDENCE TRACKING
    • AUTOMATED IMPORT OF PROVIDER FEE SCHEDULES
    • AUTOMATED CALCULATION OF PROVIDER FEES AND CODES
    • CAPITATION PAYMENT PROCESSING
    • AUTOMATED MAPPING FROM PROVIDER CODES TO ICD10 OR CPT STANDARD CODES
    • DRG MANAGEMENT

    • 837 CLAIMS IMPORT AND EXPORT
    • 834 ELIGIBILITY IMPORT AND EXPORT
    • 835 REMITTANCE ADVICE PROCESSING
    • 999 ACKNOWLEDGEMENT

    • POLICY HISTORY FOR EACH GROUP
    • SPECIFIC STOP LOSS, AGGREGATE STOP LOSS AND FULLY INSURED POLICIES
    • AUTOMATIC DETERMINATION OF STOP LOSS LIMITS BEFORE CLAIMS ARE PAID
    • SPECIFIC POLICY STOP LOSS % OF LIMIT REPORT
    • AGGREGATE POLICY CLAIMS REPORT
    • SUPPORT FOR MEDICAL, DENTAL, VISION AND LIFE PRODUCTS AND ADMIN FEES
Advanced Features of Claimscape Health Benefits System
  • Simplified Eligibility Processing
  • Integrated Scanning and Document Management
  • Built-In Electronic Pre-Authorizations and Scanned Claims Support
  • Advanced Security
  • Rapid Pre-Authorization Queue Processing From Electronic or Other Links
  • Real-Time Web Access for Insureds, Providers and Groups
  • Multi Level Group Security With Logging of All Events
  • Multiple Company, Multiple Database Support
  • Claims, Preauthorization, and Customer Service Queues for Maximum Efficiency and Optimized Workflow
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DataGenix gives you a clear view of your operations with technology and innovation that simplify the complexity of claims processing and health care benefits management.

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  • info@datagenix.com
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