CAI Strategic Partners:    

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.

Carrier Level Cost Containment
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.
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.

Claims Adjudication Systems
CAI has developed enhanced EDI connections with each of the adjudication systems partners listed.

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:
V Provides secure, 24/7 access to selected live LuminX data and a real-time Comprehensive Enrollment Wizard with the LuminX Information Network (LIN)
V Automatically adjudicates all claims on a uniform and consistent basis
V Transforms the claims processing function into a paperless activity
V Provides Electronic Data Interchange (EDI) and Optical Character Recognition (OCR)
V Supplies customer service reps with instant access to all required data
V Automates claims inquiries/requests for Verification of Benefits Faxes through Interactive Voice Response (IVR), available 24/7

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.

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:
V Increased automation
V Decreased cost
V Faster turnaround times
V Ability to track routed transactions
V Greater network flexibility

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.

Healthcare and HIPAA Consulting

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.

Scanning - OCR Imaging / Data Entry / Data Management
CAI works with both companies to offer its paperless repricing and adjudication solution, EDIPlus!

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.

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:

V Complete inbound mailroom
V Data capture from paper and image, including OCR/ICR
V Digital conversion for paper documents and medical and dental x-rays
V Medical and dental claims processing and pre- and post-adjudication
V Data warehousing, hard copy storage and retrieval, image retrieval services
Data Dimensions’ services allow you to focus on your core competency while drastically reducing your costs and dramatically improving your turnaround.
home    employment    glossary    hipaa    press    security    site map