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CAI Strategic Partners: |
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At Coalition America, Inc. (CAI) we are constantly looking for opportunities
and relationships that can provide additional value to our clients. Listed below
by category are companies with which CAI has entered into strategic relationships.
We encourage you to consider these organizations if you are in the market for the
services they offer.
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For more information about CAI’s strategic partners, please contact Corte Iarossi, Director,
Strategic Business Development at (404) 459-7201 ext. 5337 or
corteiarossi@coalitionamerica.com
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Carrier Level Cost Containment
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Lodestone Solutions, LLC is a healthcare centric database company integrating
demographics, validation information, and quality characteristics across extensive
profession types and areas of practice. The company compares and matches data
from various disparate data sources to identify the most accurate depiction of
the individual provider and group practice. In addition to providing data content,
the company provides a family of data services including database cleansing,
deduplication, hygiene, address normalization, geo-coding, etc.
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Bloodhound, Inc. provides claims editing and business analytics services to all
participants in the claims revenue cycle. Its services, technologies and products
combine to offer any payor of claims the most comprehensive solution to preventing
overpayment or miscoding of claims. Delivered as an ASP application, Bloodhound’s
premier service, ClaimsGuard, enables real time edit processing of claims for accuracy
including duplicates, up-coding, rebundling, and unbundling of codes. Customers engage
Bloodhound to improve their profitability, increase auto-adjudication rates, gain
insight into provider/payor historical behavior and assist them in building more
efficient claims processes.
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American Health Data Institute (AHDI) partners with TPAs and employers to provide
analytical business intelligence regarding healthcare expenditures. By data mining
claims and pharmacy data, AHDI can implement effective disease management strategies,
develop predictive risk models and identify high quality, cost effective service providers.
By turning data into intelligence, AHDI has demonstrated a 5-15% average reduction on
overall healthcare cost while enhancing the quality of healthcare delivered.
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EDIWatch, Inc. is the premier provider of focused anti-fraud solutions to the healthcare
payor industry. EDIWatch’s breakthrough suite of reliable, innovative products and
services addresses all three objectives of an anti-fraud initiative: Detection, Recovery,
and Prevention. EDIWatch’s clients are implementing this solution in Medical Affairs,
Internal Audit, and Provider Relations departments to improve productivity, efficiency,
and maximize bottom-line savings.
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Claims Adjudication Systems
CAI has developed enhanced EDI connections with each of the
adjudication systems partners listed.
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Acclamation Systems, Inc. is the developer of LuminX, a comprehensive benefits
management system that seamlessly integrates HIPAA compliant functionality in the areas of
claims processing, group billing and administration, online enrollment and accounting. LuminX
combines sophisticated design with document imaging and the latest Internet capabilities to help
companies achieve the lowest cost per claim in the industry. LuminX effortlessly integrates all
aspects of your benefits management administration:
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Provides secure, 24/7 access to selected live LuminX data and a real-time
Comprehensive Enrollment Wizard with the LuminX Information Network (LIN) |
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Automatically adjudicates all claims on a uniform and consistent basis |
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Transforms the claims processing function into a paperless activity |
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Provides Electronic Data Interchange (EDI) and Optical Character Recognition (OCR) |
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Supplies customer service reps with instant access to all required data |
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Automates claims inquiries/requests for Verification of Benefits Faxes through
Interactive Voice Response (IVR), available 24/7
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Hi-Tech Health, Inc. is an application service provider offering customized software solutions
and systems to third-party administrators, insurance companies, preferred provider organizations
and large companies wishing to self-administer health benefits. Our systems combine reliability,
flexibility and usability with features tailor-made for your specific needs. We provide 24-hour
eligibility and claim verification, interactive web interface, fax on demand, auto-adjudication and
repricing, HIPAA compliant EDI interface, system integrated UCR, CPT and claim edit modules,
scanning and archiving modules, consolidated billing, flexibile spending, Cobra administration
and much more.
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ClaimsExchange™ seamlessly connects users of TriZetto’s Facets™, ClaimFacts™ and
QicLink™ administrative systems to Coalition America. ClaimsExchange™ automatically selects
eligible claims based on plan information that already exists within your claim system. Claims are
then routed electronically via TriZetto’s Customer Connectivity Center, repriced, and
automatically updated back to your system. ClaimsExchange™ integrates repricing with your
claims adjudication process, resulting in:
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Increased automation |
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Decreased cost |
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Faster turnaround times |
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Ability to track routed transactions |
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Greater network flexibility |
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WLT Software, Inc. is an international provider of fully integrated Windows-based automated
claims processing and reporting systems for medical, dental, vision, disability, drugs, Flex,
COBRA, pre-certification, utilization review, case management, re-pricing, managed care,
capitation, HMO, PPO, 24 hour coverage, workers’ compensation, claims editing, premium billing,
commissions, automatic claims adjudication, HIPAA required EDI formats. MICR, fax-back, OCR,
clearinghouse, PPO access interfaces and more are also available. Ad-hoc report writing is easy
with an ODBC compliant open relational database.
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Healthcare and HIPAA Consulting
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Hazen Group, Inc. (HGI) is an extra set of hands to assist your organization in
achieving its goals. While Indianapolis-based, HGI provides short-term
management resources to a variety of businesses throughout the United States.
Our services are designed to supplement the client’s current management
capabilities by providing project oriented business support. The HGI team is
comprised of seasoned managers and leaders who can make an immediate and
significant impact for client organizations. Our consultants have been leaders
in various fields, from operations and nursing to healthcare law. HGI draws on
these combined perspectives and experiences to provide customized and complete
solutions for our clients.
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Scanning - OCR Imaging / Data Entry / Data Management
CAI works with both companies to offer
its paperless repricing and adjudication solution, EDIPlus!
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Health e Connex, a division of ARM, combines its 20 + years of
expertise in the healthcare industry with their knowledge of imaging technology
and automation solutions to provide claims processing services using OCR
technology. Health e Connex’s optical scanning process is your solution to lower
administrative costs and simplify business operations. Health e Connex is a
preferred vendor for many healthcare management systems and can integrate any
number of workflow scenarios to fit optimally with your business model.
Provides a totally paperless and HIPAA compliant system in 60 days including electronic
data management.
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Data Dimensions has been providing business process outsourcing
solutions to healthcare payors and insurance companies nationwide for more than
20 years. We reduce costs and improve quality through best practice business
processes. Our services include:
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Complete inbound mailroom |
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Data capture from paper and image, including OCR/ICR |
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Digital conversion for paper documents and medical and dental x-rays |
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Medical and dental claims processing and pre- and post-adjudication |
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Data warehousing, hard copy storage and retrieval, image retrieval services |
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Data Dimensions’ services allow you to focus on your core
competency while drastically reducing your costs and dramatically improving your
turnaround.
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