Eligibility Manager® is a uniquely configurable software solution that makes it easy for IPAs, MSOs, or any population health, delegated group or managed care organization to efficiently manage changes to healthcare member eligibility. Users can effortlessly reconcile their own data against data from all payers. The program takes as input a full or partial list of members from a health plan, and creates a list of membership changes.
What makes Eligibility Manager superior to other eligibility management programs are two main strengths. First, its unique design allows for implementation of custom processing for any health plan data format, health plan data issues, and client business rules. And second, powerful yet easy-to-use auditing tools allow eligibility analysts to quickly find and correct data issues.
In addition, Eligibility Manager is fully customizable to load and export eligibility data in any format, including ANSI X12 HIPAA formats. Combined with DataTug™, users can save hours with automatic online eligibility verification.
DataTug™ is a unique product that knows how to find the information you need quickly and accurately for any health plan. DataTug can save you hours of time every day, saving you money and increasing your productivity. DataTug extracts required data automatically from health plan web sites and ANSI X12 270/271 and other data portals.
DataTug provides real-time batch processing of eligibility verification. It has a flexible data interface that allows for searches of members provided in various file formats, or through its proprietary API.
EZ-CARE is a dedicated care management module supporting our clients clinical teams’ focus on managing risk, quality of care, reducing costs, and improving patient/member experience. This complete, easy-to-use case management application is designed for the unique workflows of the nurses, doctors, case managers and healthcare administrators engaged in care management roles.
EZ-INFO provides a complete, end-to-end population health platform for delegated IPAs, MSOs and Health Plans managing patients at risk. This solution combines everything from clinical and claims data to biometric and social information in a single location for actionable data, such as managing HCCs, HEDIS, STARS, etc., making program management simple, allowing you to effortlessly maximize revenue and reduce the future cost of care.
Cap Check is an essential tool for medical groups with capitated contracts to verify that they are receiving correct payments. By reconciling actual payments with expected payments on a member/month basis, you can verify whether you are being paid correctly, and make corrections when you are not.