The FACTS® family of products supports multiple lines of business within a single information system: Health, Indemnity, TPA, PPO, HMO, PHO, IPA, MSO, Group Administration, COBRA, Section 125-Integrated Flexible Benefits, and Workers' Compensation with Integrated Managed Care for 24-hour coverage.

Expert management of all key components of your business

• Claim and encounter processing
• Managed care administration
• Workers' compensation administration
• Policy/Benefit administration with support for eligibility, billing, collections and commissions

HIPAA Compliance

From the inception of HIPAA, the FACTS® system infrastructure has been based on HIPAA-compliant solutions. FACTS® is fully committed to ensuring a clear and easy path to HIPAA readiness - well ahead of the federally mandated compliance deadlines.

Interactive "Web" and "Voice-Enabled" Benefits Communication

FACTS® fully integrated, interactive Internet and voice-based systems empower healthcare administrators and professionals with 24 x 7 access to claims and benefit information, and real-time transactions such as EDI claim uploads, through the Internet.

Fully integrated, advanced technologies for added functionality and advanced productivity

Managed Care

FACTS Family of Products

Core Administration Products

FACTS® CLAIMS & ENCOUNTERS™ - Claim & Encounter Processing System

Fully automated, real-time processing system for complete, on-line adjudication of medical, dental, vision, prescription drug, disability, and COBRA claims and encounters. Comprehensive, yet highly flexible and easy-to-use system. Sharing of information between subsystems minimizes data entry and human intervention. Provides the necessary components for fast, accurate, and cost-effective processing.

FACTS® ADMIN™ - Policy/Benefit Administration System

Fully automated, real-time benefit administration system, with support for eligibility, billing, collections, and commissions. Addresses all aspects of health coverage remuneration for the administration of all types of health insurance. Support for both group and individual. Also accommodates life and AD&D coverage administration, and offers great flexibility in defining your life products.

FACTS® COMP™ - Workers' Compensation Administration System

Fully automated and comprehensive workers' compensation claims administration system that enables you to administer workers' compensation programs within established managed care guidelines. Adjudication of workers' compensation and health claims within a wholly unified system. Provides an extensive range of proactive cost containment strategies for effective managed care.

FACTS® 125™ - Section 125, Integrated Flexible Benefits Administration System

Fully automated, comprehensive, and integrated system for the management of Section 125, Flexible Benefit plans. Offers complete administration of a full range of flexible benefit programs, from spending accounts to a full cafeteria plan.

FACTS® DCS™ - Consumer Directed Health Plan Administration System

Consumer directed healthcare administration system providing comprehensive financial account management, seamless integration to health claims administration and flex spending account administration, consolidated reporting and explanation of benefits production, and centralized customer service response capabilities. FACTS DCS enables healthcare payer organizations to deliver consumer directed plans to your customers without interruption or increased overhead to your operations.

FACTS® COBRA™ - COBRA Administration System

Fully automated system for the administration of the Consolidated Omnibus Budget Act (COBRA). Complete, on-line administration of a wide range of individual and COBRA eligible health plans including medical, dental, vision, and prescription drugs. From initial COBRA notification through coverage termination, FACTS® COBRA performs the necessary functions to ensure COBRA compliance. Allows for the efficiently and timely flow of pertinent data for your COBRA qualifiers and participants.

FACTS® MICR™ - MICR Laser Check & EOB Encoding System

Laser printing module for print of check with an Explanation of Benefits (EOB). Enables the print of this information along with the required logo, signature, and MICR encoding in only one pass through the FACTS® MICR printer on blank security paper. Simplifies and streamlines all aspects of the check/EOB printing, sorting, and filing process while greatly reducing your administrative and overhead costs.

Managed Care Products

FACTS® PPO™ - Provider Network Management System

Fully automated provider network processing module. Provides you with a fully integrated database for providers (both practitioners and facilities) Contracts are driven by date-of-service, giving you the added capability of unlimited contract periods. Unlimited number of PPOs per plan; unlimited number of providers per PPO; unlimited number of PPOs per provider.

FACTS® CES™ - Clinical Editing & Auditing System

On-line, interactive claim editing and auditing module, which verifies claims for accurate procedure and diagnostic coding, utilizing the Ingenix™ statistical, multi-tiered claims editing database. Allows you to identify excessive and inappropriate care quickly, for effective case management and cost containment. Use of this system offers significant savings.

FACTS® PRE-AUTH & REFERRALS™ - Pre-Authorization, Utilization Review, Utilization Management & Physician Referral System

Fully automated and comprehensive pre-authorization, utilization review , utilization management, and physician referral system. Offers a full range of case management capabilities to track patient activity, as well as containment strategies for effective managed care. Industry database experience combined with the FACTS® PRE-AUTH & REFERRALS system provides an effective tool for establishing goals for treatment and protocols, enabling you to evaluate the strategies which offer you the most cost-effective savings.

FACTS® CAPITATION™ - Provider Capitation Management System

Fully automated provider capitation and sub-capitation module for use by doctors, hospitals, integrated delivery systems, and other types of Managed Care Organizations (MCOs). Supplies providers with the functionality to effectively control and manage all of the major administration needs within a capitated environment. Allows for multi-level capitation setup for multiple lines of business. Supports multiple capitation agreements with providers accommodating variable rates by age, sex, region, and plan.

FACTS® GATEKEEPER™ - Primary Care Physician Profiling & Credentialing System

Fully automated system for the administration of a wide range of Point-Of-Service (POS) plans. Supplies your FACTS® database with a comprehensive database of provider credentials and relationships for effective network and employee election management. Primary Care Physician (PCP) election at the member and dependent level; profiling and credentialing; and backup referral tracking at the plan, network, and provider levels.

FACTS® CASE MANAGEMENT™ - Case Management System

Fully automated case management system. Provides nurse managers and claims professionals with the necessary tools and information for the management and review of hospital and medical services provided through the term of an illness or event. Enables health care professionals to effectively monitor and manage all stages of patient care and treatment in a prospective, concurrent, and retrospective fashion. Highly effective utilization management tool that allows the user to more critically ensure the maintenance of quality health care at the lowest cost.

Front-End Products

OPTIFACTS™ - Optical Imaging / IOCR System

Integrated, front-end system for Intelligent Optical Charater Recognition (IOCR). Allows for on-line document imaging, scanning, storage, and retrieval. Gives you the ability to process a greater volume of claim forms directly into the FACTS® CLAIMS & ENCOUNTERS system quickly, accurately, and consistently. Using OPTIFACTS, you can scan in the original claim form to disk and obtain a printed check instantly.

FACTS® EDI™ - Electronic Data Interchange/Claim Submission System

Electronic claim submission system for the high speed entry of claims and/or member data into the FACTS® CLAIMS & ENCOUNTERS system, directly from a provider or claims clearinghouse. Enables you to transmit hundreds of claims or member records within minutes, virtually eliminating all data entry requirements. Significantly reduces the administrative overhead and costs normally associated with the claims entry process, by incorporating electronic claims processing technology.

FACTS® PRE-PROCESSING™ - Claims Pre-Processing System

Fully automated claims pre-processing system which enables your clerical and non-technical staff to perform claim data entry tasks, easily and efficiently. This pre-processing capability allows you to enter claim information and file it for processing an authorization at a later date, even if you do not have all of the general claim information. Provides your organization with an effective mailroom data entry solution which helps you reduce administrative overhead and costs normally associated with the claims entry process.

Automation Products

FACTS® CODER™ - Automatic Claim Coding System

Automated decision support system which provides for automatic coding of claims based on on-line analysis of claim parameters. Utilizes master coding templates, defined by industry experts through the critical analysis of HCFA and UB92 elements to efficiently determine the appropriate benefit classifications through benefit codes. Minimizes adjuster error in benefit code selection and standardizes claims processing throughout your organization.

AUTOFACTS™ - Automatic Claim Adjudication System

Parameter driven, automatic adjudication module that adjudicates claims quickly, easily, and accurately, with minimal adjuster intervention. Collects claims received via modem, tape, or diskette (using FACTS® EDI), via optical imaging and IOCR (via OPTIFACTS), or via mailroom data entry (using FACTS® PRE-PROCESSING) and creates a batch for automatic adjudication.

FACTS® WDS™ - Electronic Claim Workflow Distribution System

Electronic claim workflow management system for your adjusters. Provides automatic routing of claims entered into the FACTS® CLAIMS & ENCOUNTERS system via FACTS® EDI, OPTIFACTS, or FACTS® PRE-PROCESSING to adjuster work queues on a real-time basis. Ensures your adjusters have the most current and accurate workload possible. Provides your organization with a dynamic environment for enhancing claims throughput and turnaround time.

FACTS® REPORTER™ - Custom Report Generator System

User-friendly, parameter driven and comprehensive ad-hoc report generator. Extremely powerful, yet easy-to-use system for the production, maintenance, scheduling, and running of custom and standard reports. Utilizes the information maintained by the user's FACTS® database. Flexible, custom reporting capabilities provide a wide range of options for specifying the data you want to include in a report, and the formatting parameters for report design.

Interactive Products

FACTS®Web™ - Real-time, Internet Based Claim, Coverage & Benefit Generation System

First e-business platform designed specially for healthcare administrators using the FACTS® system. Facilitates the sharing of real-time information directly from your FACTS® system to insureds, employees, and provider's web browsers through the Internet. Eligibility, plan summary, and claim status information is available in a real-time fashion, 24 hours a day, seven days a week, 365 days a year. Secured and protected access. Leverages the power, connectivity, and efficiency of the Internet into your FACTS® health claims management environment. Includes EDI claims upload capability.

FACTS® IVR™ - Real-time, Telephony Based Claim, Coverage & Benefit Generation System

Interactive voice response system which gives employees, providers, and employee benefit administration representatives access to benefits eligibility and claim status information 24 hours a day, seven days a week, via touch-tone phone. No human intervention required; calls are automatically answered by the system. Gives your customers access to information when they want it, in a timely and consistent manner. Fax back capability also provided.

FACTS Software Solutions

With the FACTS® Custom-Tailored Software Solution you have the option of selecting a complete FACTS® system, fully integrated for optimum efficiency - or you can choose only those modules that meet your specific needs.

System Benefits & Advantages - AT-A-GLANCE

• Easy-to-learn and easy-to-use systems, with on-line help throughout, that are easily understood by non-technical personnel.
• Fully on-line, parameter-driven systems that works the way you do - making it easy to process data and generate reports.
• Flexible, user-defined operation adapts to a wide range of changing conditions.
• Administrative functions that meet your needs with minimal human interaction.
• An inherent flexibility that permits the user to establish system parameters while incorporating cutting-edge technology for maximum productivity.
• Modular/integrated system design allows for multiple processes to run concurrently.
• Improves efficiency and productivity throughout the organization.
• Yields improved cash flow.
• Enhanced control of health care utilization and excessive costs.
• Extensive reporting capabilities; standard and custom report generation.
• Fast and easy implementation with minimal disruption to your existing business practice.

FACTS Hardware Solutions

FACTS® & Open Systems - A Winning Combination

The combined technology of FACTS® and open systems architecture offers a solid, technical foundation for the most powerful, open and flexible health claims management system in the industry. You can choose from a number of cost-effective hardware options provided by FACTS® Services, Inc. to match your growing needs - so you will never have to worry about obsolescence or expensive software conversions.

From Windows to Unix, FACTS® can provide your organization with the hardware and software combination that is just right for your current operation and future goals.

Whether you are automating for the first time or need to upgrade your current environment, FACTS® supplies a wide range of high performance open systems. These systems offer unparalleled processing power - under even the most demanding of workloads. Whatever your business size, FACTS® can provide you with the best configuration for your specific needs. After all, the best software deserves the finest of operating environments.

FACTS Services

To ensure your company consistent, quality service, FACTS® "full-service" support program is structured into multiple levels of assistance - from day one of installation throughout system use. Every new FACTS® client is assigned a team of representatives from our development, applications support and technical services staff. This group is available to address any problems or questions you may have regarding system use.

These system specialists ensure that your needs are identified, weighed and serviced in the most efficient and productive manner, from the initial implementation plan, training and data conversions, to ongoing system use. Additionally, FACTS® provides ongoing software maintenance, along with comprehensive user documentation for every system you use. With software maintenance, you also get software releases providing the latest product enhancements, professional and courteous phone support, and 24-hour on-line and modem support. The FACTS® development team is also available to perform customized programming requests to ensure your specific needs are always addressed.

FACTS Software Support

FACTS® Customer Support Center is staffed with employee benefit and health claims management experts and technical personnel to provide problem solving support. FSI offers a variety of support services geared towards meeting your organization's specialized needs.

Unlimited phone support

8:30 a.m. to 5:30 p.m. (Eastern time) Monday through Friday. All calls are taken by knowledgeable specialists who isolate the issue and delegate it to the appropriate in-house personnel for fast action.

24-hour online and modem support

24 hours a day, seven days a week.

Extended Remote Supportsm (ERS^sm)

Prompt, full-service user assistance (software/technical) outside the regular work hours (evening/weekends/holidays). To obtain this service, the user contacts FSI in advance to schedule and contract the time they wish to have access to this support. During this coverage time, the user has immediate access to the FSI remote support team for fast and easy problem resolution.

FACTS® Professional Services Group^sm

Consultation and assistance for software and hardware, system implementations, network services, and a variety of specialized services.

FACTS Education & Training

Any system, regardless of how well designed and programmed, will only perform up to the level of its users' capabilities. And the more your staff knows about FACTS®, the better it serves them. For this reason, FACTS® offers one of the most extensive and thorough initial training programs of any system on the market. Training is provided on site and/or in FACTS® home office - depending on individual needs and the complexity of the systems selected.

Educational Programs & Networking Opportunities for FACTS® Users

As additional educational and networking resources for FACTS® users, Ebix Health annually sponsors the INTERFACE training program for hands-on instruction for the upcoming FACTS® release and the FACTS® User Group Conference, which offers an informative mix of presentations and breakout sessions focusing on pertinent industry issues and the role that FACTS® technologies play in addressing them. The conference curriculum for both of these programs focuses strongly on user-requested topics.

FACTS Business Solutions

The Ebix Health - Miami Customer Support Center, in Coral Gables, Florida, is staffed with employee benefit and health claims management experts and technical personnel to provide problem solving support. FSI offers a variety of support services geared towards meeting your organization's specialized needs.

FACTS Industry Links

The Ebix Health - Miami Customer Support Center, in Coral Gables, Florida, is staffed with employee benefit and health claims management experts and technical personnel to provide problem solving support. FSI offers a variety of support services geared towards meeting your organization's specialized needs.

Self-Insurance Institute of America, Inc. (SIIA)

SIIA is the only national association dedicated exclusively to protecting and promoting the self-insurance risk financing alternative for both group health plans and workers' compensation programs. Founded in 1981, the association has grown significantly, now including members from virtually every state and several countries around the world. SIIA provides membership services in four primary areas: information, education, networking, and legislative/regulatory representation. www.siia.org

Health Insurance Association of America (HIAA)

HIAA is the nation's most prominent trade association representing the private health care system. Its more than 300 members provide health, long-term care, dental, disability, and supplemental coverage to more than 123 million Americans. It is the nation's premier provider of self-study courses on health insurance and managed care. www.hiaa.org

National Managed Health Care Congress (NMHCC)

The NMHCC serves as a knowledge source for the triad of health decision-makers, purchasers, payors, and providers, and seeks to increase the quality and cost effectiveness of healthcare delivery nationally and globally through the identification and communication of new ideas, best practices and innovative clinical and management solutions. Since 1998, it has served tens of thousands of health professionals through quality and timely educational programs, and serves as the conduit to innovative vendors and suppliers developing solutions to the industry. www.nmhcc.org

FACTS Partners