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EbixEnterprise Claims
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EbixEnterprise Claims provides the flexibility you need to manage the full spectrum of health and employee benefits. Each EbixEnterprise Claims LX Business Block™ covers a specific line of business and, when combined together, they form a powerful benefits management system. The EbixEnterprise system also offers online benefits enrollment and eligibility; web-based reporting and business intelligence; and fully integrated financial capabilities.
EbixEnterprise Claims LX Overview
Ultimate flexibility
EbixEnterprise Claims LX is uniquely structured-in Business Blocks, allowing you to change coverage categories as your book of business changes. And every block is built on the powerful EbixEnterprise Claims LX Foundation, with online enrollment and eligibility management, remote access capabilities, and advanced reporting and business intelligence.
Integrated compatibility
EbixEnterprise system software was originally built and is maintained as one, fully integrated system. From online enrollment to adjudication to billing, it's a complete benefits management system.
On-demand data accessibility
EbixEnterprise Claims captures hundreds of data points and all relative health and employee benefits data, including claims images, plan parameters, eligibility, etc. And it's all accessible through easy-to-navigate menus for more efficient benefits administration.
Cost-effective scalability
EbixEnterprise Claims is available as an in-house program or via a Software-as-a-Service (SaaS) model. With SaaS, we host EbixEnterprise on our servers at our state-of-the-art data center, freeing you from the expense of software implementation and maintenance. Add lives and capabilities as your business grows, and let us manage the IT.
EbixEnterprise Claims LX Business Blocks
Absence Management LX
Our Absence Management solution includes the following:
Short-Term Disability (STD)
Long-Term Disability (LTD)
The STD and LTD blocks both provide eligibility, billing and remittance of claims, integrated document scanning and storage, and remote real-time access. You also get the full, underlying power of EbixEnterprise Claims business applications, including:
- Online enrollment capabilities: Allow participants access via the Web during open enrollment and as life-events occur.
- Administrative and financial capabilities: Can integrate with or serve as your base accounting program.
- Comprehensive and business intelligence capabilities: Allow you an immediate access to critical business data and analysis.
Consumer LX
Our Consumer LX solution includes the following:
Flexible Spending Accounts
Health Reimbursement Accounts/Health Savings Accounts
FSAs, HRAs and HSAs are becoming increasingly popular, but can be complex to administer. Our Consumer LX Block simplifies the benefits administration process, so that your customers and participants are able to rely on accurate and timely processing of reimbursements. Eligibility, billing and remittance of claims, integrated document scanning and storage, and real-time remote access are provided. You also get the full, underlying power of EbixEnterprise Claims business applications, including:
- Online enrollment capabilities: Allow participants access via the Web during open enrollment and as life-events occur.
- Administrative and financial capabilities: Can integrate with or serve as your base accounting program.
- Comprehensive reporting and business intelligence capabilities: Allow you an immediate access to critical business data and analysis.
Dental/Vision LX
The programs in our Dental/Vision LX solution handle the benefits administration for dental and vision coverage. Eligibility, billing and remittance of claims, integrated document scanning and storage, and real-time remote access are provided in each of these. The dental program also provides a detailed transaction history of all dental treatments for auditing claims and user-defined dental logic, to determine the appropriate treatment sequence. Plus, you get the full, underlying power of EbixEnterprise Claims business applications, including:
- Online enrollment capabilities: Allow participants access via the Web during open enrollment and as life-events occur.
- Administrative and financial capabilities: Can integrate with or serve as your base accounting program.
- Comprehensive reporting and business intelligence capabilities: Allow you to see the claim at any point during the process.
Health LX
The Health LX Block handles the medical benefits administration and COBRA administration. It is flexible enough to perform eligibility management, adjudication, billing and remittance of claims across a wide variety of health insurance plans.
COBRA
Our COBRA program simplifies COBRA administration. It automatically produces all required notifications, tracks enrollment periods for group health continuation, and bills premium to those electing to continue their health coverage.
HIPAA
Our HIPAA software program translates incoming data in HIPAA formats into your benefits management application and, conversely, extracts your application data and translates it back into HIPAA formats using the required HIPAA code sets. It reduces costs by reducing claim processing backlogs, improving turnaround times, freeing up examiner time, reducing printing, mailing, scanning and indexing costs, and reducing/eliminating data entry errors.
All of the EbixEnterprise system LX Business Blocks provide eligibility, billing and remittance of claims, integrated document scanning and storage, and real-time remote access. You also get the full, underlying power of EbixEnterprise Claims business applications, including:
- Online enrollment capabilities: Allow participants access via the Web during open enrollment and as life-events occur.
- Administrative and financial capabilities: Can integrate with or serve as your base accounting program.
- Comprehensive reporting and business intelligence capabilities: Allow you to see the claim at any point during the process.
Insurance LX
Our Insurance LX solution includes the following:
Group Life
Accidental Death and Dismemberment (AD&D)
The EbixEnterprise system’s group life and AD&D software programs document the data necessary to track the required investigation process prior to disbursement of a death or accident benefit. Our blocks provide for the classification and storage of proof documents, such as the Death Certificate, by integrating the document image into the claim data for easy viewing and retrieval. Eligibility, billing and remittance of claims are also provided in each of these. Plus, you get the full, underlying power of EbixEnterprise Claims business applications, including:
- Online enrollment capabilities: Allow participants access via the Web during open enrollment and as life-events occur.
- Administrative and financial capabilities: Can integrate with or serve as your base accounting program.
- Comprehensive reporting and business intelligence capabilities: Allow you to see the claim at any point during the process.
EbixEnterprise Claims LX Foundation
When you purchase any EbixEnterprise Claims LX Business Block, you get the powerful capabilities of our Foundation, the financial and administrative cornerstone of EbixEnterprise Claims. The EbixEnterprise Claims LX Foundation includes:
General Ledger
The GL system is designed to function as both a single and multi-company ledger. You define the parameters -- including definitions of the companies, financial statements and posting parameters.
Accounts Payable
The AP system is a full-function accounting package, which operates both independently and as an integral part of the EbixEnterprise claims processing system. Here you can maintain a complete vendor file, manually enter vouchers from vendor invoices, process payments, print checks and prepare a variety of reports.
Accounts Receivable
The AR system tracks invoices to be billed to client accounts and posts cash to these invoices, allowing you to make inquiries and adjustments as necessary, and prepare a variety of reports.
Billing
EbixEnterprise Claims Billing combines participant eligibility data with billing formula data and produces billing detail reports, invoices, vouchers, GL entries and a detailed billing history.
Administration
The Administration functionality allows you to set up groups and divisions and build plans for each.
Online Enrollment & Eligibility
Enrollment and Benefits Review Made Easy-for You and Your Clients
The EbixEnterprise Claims Comprehensive Enrollment Wizard (CEW) is a powerful tool that makes the online enrollment process easy. Participants, employers and administrators can perform self-serve enrollment and eligibility management transactions via the Web while maintaining seamless integration with the EbixEnterprise Claims system.
What Makes Our Online Enrollment Different?
Rules-based Enrollment: A powerful rule set is used to determine eligibility so that the only benefits offered are those, for which an employee qualifies.
- EbixEnterprise Claims Extensibility: Benefits or coverages that can be built in EbixEnterprise Claims can be enrolled in via the Web.
- Timeliness: Once approved by the Benefits Administrator, benefit changes are immediate.
- Full Integration: No downloads; no uploads. CEW seamlessly integrates with your EbixEnterprise Claims system.
Benefits
- Replaces time-consuming paperwork and increases accuracy with employee self-serve enrollment.
- Tailors employee benefits choices to only those, which the employee is eligible for-- further increasing enrollment accuracy.
- Handles open enrollment and changes in status - for life-events salary or job changes-- further reducing HR involvement.
- Expand your reach by offering your employers and employees e-business capabilities with the CEW online enrollment tool.
Reporting & Business Intelligence
Transform Data into Powerful, Decision-Making Information
The iBIZ online reporting tool brings together world class business intelligence technology and the Internet for advanced reporting and distribution. iBIZ is a complete business intelligence solution that delivers critical analysis with zero footprints, since it's 100% available through a browser. Customers get robust functionality with no plug-ins to install and no end-user complexity - which translates into a lower cost of ownership and higher customer satisfaction.
Access Data 24/7
- Access business intelligence such as paid claims, total plan cost and premium expense
- Perform detailed analysis to help make important business decisions
- Run reports for Total Plan Cost, Total Plan Cost by Enrollment, Claims Analysis, Large Claims and others
The iBIZ business intelligence solution gives you an immediate access to the information that is critical to operations and decision-making, with flexible presentation options, and drills-down functionality for a detailed review.
Want to learn more? Watch the iBIZ auto-play presentation
Professional Services
Consulting
The EbixEnterprise consulting team will help you achieve the best ROI from your benefits management system by aligning it with your business objectives and assisting you in achieving the ultimate output. Decades of combined experience in employee benefits technology allows us to see your business through your eyes. We implement the processes and integrate the technology to give you a competitive edge as a healthcare payors.
Consulting areas include:
- Business process improvement
- Line of business consulting
- Operational services consulting
We also provide business services that can augment and extend your business offerings, such as consolidated billing.
Customer Support
Our number one priority is customer satisfaction. We have an experienced staff who will listen to your EbixEnterprise support and enhancement issues, and develop viable solutions to meet your needs. Whether you need an answer to a product inquiry or help with a technical issue, the Ebix team is here to help.
With the help of our Ebix experts, you can make our system sing. We offer three types of service:
Customer Service: To answer basic questions on system usage, claims payment, report balancing, etc.
Product Support: To answer product-specific issues that require technical program expertise, such as file system issues, program revisions, changes to report output, etc.
Technical Support: To assist you with IT-related issues, such as server installations, network configurations, hardware upgrades, etc.
Implementation
Ebix Health has a dedicated team to plan and manage the implementation process. We'll work with you to determine the best approach and manage the project effectively.
EbixEnterprise Project Management
Drawing on years of project management and planning experience, we will explore the project and agree on the scope of work. The assigned project team will manage the planned tasks throughout the project, paying close attention to the project communication with the client. Our efforts will be focused with an eye on the project's target, the go-live date.
EbixEnterprise Data Conversion
We manage all aspects of the conversion process, mapping the incoming data to EbixEnterprise and creating programs to facilitate the data loads. We will assist you in cross-referencing the incoming data, strategizing on a data review and test plan, and its movement from the testing system to the production system.
EbixEnterprise Training
The project plan will incorporate time for application training prior to the "go live" date. Product functionality will be covered as well as how to best incorporate EbixEnterprise functionality into your business requirements. Complete product consulting services are also available.
Training
New Client Training
For new clients, we offer a 2-day session called EbixEnterprise Claims 101, which focuses on becoming familiar with solution’s terminology and the overall capabilities of the system. Upon completion, clients are asked to complete a workbook of questions relative to their business and procedures. This pre-training workbook allows us to become familiar with the client's current processes and future needs. Training based on the client's self-reported needs is offered next to it.
Training classes encompass all areas for which the client will utilize EbixEnterprise Claims.
Classes offered include, but are not limited to:
- Group, Plan and Benefit Building
- Accounting and Billing
- Workflow 1 (Scanning, Eligibility, Indexing)
- Workflow 2 (Examining, Payment Cycle, Customer Service)
- HIPAA/LIN (EbixEnterprise Claims Information Network)
- CEW (Comprehensive Enrollment Wizard)
- Auditing
- Voids and Refunds
- Reporting
- COBRA
- Stop Loss
- Disability
- Flexible Spending
Ongoing Training
In order to keep our clients up-to-date, functional review seminars are offered on a weekly basis for a nominal fee. The seminars, which are conducted remotely, represent recent enhancements to the system, review of current processes or timely information based on multiple client requests.
In addition, workshops may be offered on lengthier topics and clients are invited to attend the training sessions at ASI. Past workshops have included advanced plan building, voids and a year in review.
At any time, clients may request training for any area, in which they need assistance.
Hosting Services
EbixEnterprise is available as an in-house program or via a Software-as-a-Service (SaaS) model. With SaaS, we host EbixEnterprise on our servers at our state-of-the-art data center. The benefits of this model to you are:
- No on-site deployment, reduces time to implementation
- Hardware and software maintenance costs are significantly reduced
- Large, upfront licensing fees are eliminated
- Monthly subscription fees provides you with more predictable operating expenditures
- Secure, redundant hosting facility provides near to perfect uptime and HIPAA-compliant processing
EbixEnterprise software and its delivery models offer the ultimate in operational flexibility. By providing our healthcare benefits management software as a service and organizing it in Business Blocks™, Ebix Health enables healthcare payers with an option to "plug" in and out of each line of the business as they grow or down size.
Partners
The products of our Strategic Alliance Partners family enhance the value of the EbixEnterprise Claims system.
EQHS
eQHealth Solutions is an innovative population health management company that provides comprehensive technology and service solutions supporting utilization management and care management programs. eQHealth provides third-party administrators (TPAs) and self-insured employer groups with leading-edge population health management technology that can be coupled with utilization management and care management services. eQHealth’s population health management solutions are focused on the ability to proactively manage and optimize member health while significantly improving the financial well-being of the organization. TPAs and self-insured employer groups will benefit from eQHealth’s HITRUST and CMS-certified technology platform, eQSuite®, that promotes clinical integration between disparate stakeholders providing a comprehensive 360-degree view of member health, including social and economic factors. eQSuite® Population Health Management Technology proactively identifies high-risk, high-cost members and populations with its extensive predictive modeling and machine learning capabilities. The system helps guide members to the right care at the right time utilizing integrated evidence-based assessment tools and embedded clinical guidelines. eQSuite® Business Intelligence and Healthcare Analytics Technology delivers hands on access to properly interpreted information providing actionable information supporting advanced predictive modeling & risk stratification initiatives.
https://www.eqhs.com/ebixpartnership
Primary Sales Contact:
Carol Brown
cbrown@eqhs.com
Phia Geoup
The Phia Group, LLC is an experienced provider of healthcare cost containment techniques offering comprehensive subrogation and overpayment recovery, consulting services, plan document drafting, claim negotiation, balance billing defense, and plan defense, all designed to control costs and protect plan assets. Our mission is to reduce the cost of healthcare through innovative technologies, legal expertise, and focused, flexible customer service. By providing the industry with best practices and staying true to a forward thinking methodology, The Phia Group boasts an all-encompassing cost containment program for the ever-changing healthcare industry.
Primary Sales Contact:
Scott Byerley
sbyerley@phiagroup.com
WEX
For third-party administrators, WEX Health provides the depth and breadth of functionality and deployment options that no other solution can offer. With WEX Health Cloud, TPAs gain a proven web-based technology platform that administers consumer-driven healthcare accounts including HSAs, HRAs, FSAs, VEBAs, COBRA, defined contribution, wellness, and transit plans. Combined with our web portals, debit cards and mobile app, consumers have multiple ways to access and spend their funds. The WEX Health Cloud platform currently helps over 390,000 employers and 32 million consumers better manage healthcare expenses.
https://www.wexinc.com/solutions/health-cloud/
Primary Sales Contact:
Emily Tate
etate@wexhealthinc.com
Zakipoint Health
"Employers and employees are looking for ways to save on healthcare costs. You need to quickly help CFOs save on healthcare costs leveraging actionable insights, and promote appropriate healthcare providers to members e.g., telemedicine to risky members of the population. Not an easy challenge to overcome.
Zakipoint Health (ZPH) helps TPAs to integrate their customers' healthcare data into one place to radically change the way you show cost saving opportunities, and promote these opportunities to the right members at the right time e.g., use mail order medication instead of retail Rx, or telemedicine service instead of ER, preferred provider with lower costs and higher quality, or close a gap in care. And do it with a simple mobile experience that connects the member and drives change.
With us, employers are identifying 15% worth of cost savings and getting 50% higher usage of programs and incentives by members. Be ready for the change. Learn more about how you can solve this challenge here. "
https://portals.sharekits.com/
Primary Sales Contact:
Dipali Dey
dipali.dey@zakipointhealth.com
Zelis
"Zelis is the healthcare industry’s leading claims cost and payments optimization platform with superior technology and solutions to price, pay and explain claims, all at enterprise scale on a claim-by-claim basis. Zelis leverages proprietary technology, robust analytics, extensive payment and provider networks, and innovative claim savings channels to deliver administrative and medical cost savings. Zelis was founded on a belief that there is a “better way” to determine the cost of a healthcare claim within a pre-payment environment, manage payment related data, and make the claim payment. Zelis has over 1,000 associates who serve more than 700 payor clients, including TPAs, Health plans, and self-insured employers, and more than 1.5 million providers, delivering more than $5B of claims savings, $50B of provider payments and 500 million payment data communications annually. Partner with Zelis today to ensure appropriate reimbursement of care and maximized savings."
Primary Sales Contact:
William G. Schneider, Sr.
William.Schneider@zelis.com
Zelis Healthcare
Focus: Health Care Cost Containment, Electronic Payment
Zelis Healthcare is an information technology company which utilizes an end-to-end technology platform to fulfill the claims cost management and payments needs of healthcare payers including large and medium-sized health plans, TPAs, Taft-Hartley Plans, providers and individuals. The company provides a comprehensive portfolio of network management, claims integrity, payment remittance solutions and analytical services for medical, dental and workers’ compensation claims to over 500 payer clients. Additionally, the company delivers electronic payments and explanation of payments to over 270,000 healthcare providers and serves individuals with provider lookup and medical referral services. By providing access, analytics and validating claim accuracy at every step of the continuum through our leading edge technology and high-touch approach, we uncover incremental value that significantly adds to your bottom line.
Redcard
Focus: Enrollment Commmunication, Claims Communication (EOBs), Provider payments
For years, all of us at RedCard have been working to improve the way health plans and TPAs connect with members and providers. We’ve explored how to make the mountain of data more meaningful. How to make every piece of communication more useful. And how to make payments move faster.
Website: www.redcard.com
Verscend
Focus: Health Care Cost Containment
Verscend Payment Accuracy is the industry’s only real-time, pre-pay, integrated claim accuracy and fraud detection solution scalable for any size of payer. A convergence of technology, data, and analytics, our solutions incorporate a unique element: expert clinical review, a process that drives increased accuracy of claims payment.
Website: www.verscend.com
AG Healthcare
Focus: Health Claims Repricing
PlutoX
A&G's proprietary platform for real-time claims repricing, advanced claims editing, error detection and fraud, waste, abuse prevention. A&G/PlutoX is partnered with LuminX and can work with all various file formats through secure internet connections.
PlutoX Pay
PlutoXPay gives you full transparency and oversight of the payment process. The PlutoXPay system puts you in control of Payment Reconciliation, Banking, Provider Communications, EFTs, checks, Virtual Card payments and interchange revenue. PlutoXpay also offers a patent-pending “virtual check” payment solution as well as an EFT Plus solution that solves your providers’ re-association issues.
Pluto-RX
Advanced Pharmacy Audit & Recovery Solutions
- FREE evaluation of PBM contracts
- Identifying and recovery of overpayments based on PBM contracts
- Identifying areas of savings based upon overpayment or Industry Averages Benchmark Pricing
- Contingent fees based on recovery of overpayments
Website: www.aghealth123.com
Change Healthcare
Focus: Enrollment and Claims Communication, Payment Integrity, Electronic Payment
Change Healthcare is one of the largest independent healthcare technology companies in the United States, offering software and analytics, network solutions and technology-enabled services to help customers improve efficiency, reduce costs, increase cash flow, and more effectively manage complex workflows. Ebix has partnered with Change Healthcare to help customers achieve the following:
- Improve member experience with multiple electronic payment options, color printing, high-quality ID cards and welcome kits.
- Identify inappropriate claims before they are paid with Payment Integrity solutions
- Simplify your workflow with advance Eligibility and Claims Status solutions
Website: www.changehealthcare.com
BASELoad & W9 Corrections
Focus: Health Claims Provider Clean Up, 1099 Processing
BASELoad & W9 Corrections is a provider data service vendor - laser focused on enhancing auto-adjudication rates by cleaning, validating, and fulfilling medical and dental provider information. During BASELoad’s near 20 years in the health industry, custom solutions have been created and perfected to achieve 99% provider matching accuracy with electronic claims. BASELoad’s main services include, but are not limited to, a full provider database clean-up, provider fulfillment data updates, EDI provider matching service (SureHit), as well as PPO provider and fee schedule updates. Over the years, BASELoad has performed countless claims systems conversions, repricing utilities, routing, web portal lookups and many client specific custom programs.
W9 Corrections, BASELoad’s daughter company, is the original inventor of the complete outsourcing solution for the 1099 process, established in 2010. Simply send W9 Corrections your IRS file, and W9 Corrections will manage the entire lengthy and tiresome process from start to finish, inclusive of W9 mailings, B Notices, 2nd B Notices. W9 Corrections will establish the legal name/Tax ID combination, by bouncing the file against W9 Corrections internal database comprises of millions of confirmed legal Tin/Name Combinations. While using W9 Corrections, clients success rate is 99%, with no client ever receiving a fine from the IRS.
Please visit www.baseload.com and www.w9corrections.com for more information.
The Phia Group, LLC
Focus: Claims Subrogation, Legal Support
Description: The Phia Group, LLC is an experienced provider of health care cost containment techniques offering comprehensive consulting services, legal expertise, plan document drafting, subrogation and overpayment recovery, claim negotiation, and plan defense designed to control costs and protect plan assets.
Website: www.phiagroup.com
Context
Focus: Health Care Data and Pricing
For almost 20 years Context 4 Healthcare has provided Ebix customers with industry leading coding and UCR fee data. Our cloud based Payment Integrity, FWA and real-time Medicare pricing expand Ebix customer value with leading edge innovation. Immediate, actionable and defensible results make sure your plan is always protected. Context 4 Healthcare, your innovation partner since 1988.
FAIR Health
Focus: Health Care Data and Pricing
FAIR Health is a national, independent, nonprofit organization dedicated to bringing transparency to healthcare costs and health insurance information through comprehensive data products, consumer resources and health systems research support. FAIR Health uses its database of billions of privately billed medical and dental healthcare claims to power an award-winning free consumer website available in English and Spanish and to create data products serving all healthcare stakeholders, including government officials, insurers, researchers, consumers, employers, brokers, hospitals, medical facilities, doctors and third-party administrators (TPAs). For more information, visit www.fairhealth.org.
Firstsource
Focus: Claims Processing, BPO Services
With industry-leading technology, proprietary systems and processes, secure and centralized data management, and highly trained and experienced staff, Firstsource offers the solutions to make that most essential of functions—establishing end-to-end operations, optimizing existing processes, and providing our own assistance and expertise for claims processing that helps our clients thrive.
Website: www.firstsourcehealthcare.com
HealthCostManager
Focus: ACA form delivery and IRS Reporting
HCM File ACA Reporting helps employers generate ACA reporting for forms 1094 and 1095 through and easy-to-use Web-based software solution. TPA’s and advisors can generate ACA reporting within minutes using HCM File’s intuitive reporting engine. HCM file will generate outputs for employee 1095-B and C and employer 1094-B and C forms as well as electronic filing to the IRS by combining data from various sources. Click here to learn about our client experience.
Website: www.healthcostmanager.com
INETICO
Focus: Health Care Cost Containment
INETICO writes the rules on achieving optimal health with a variety of healthcare cost containment solutions. A United Claims Solutions Company, and nationally recognized industry leader that is URAC accredited in Case Management, Disease Management & Health Utilization Management. Innovative solutions include referenced based repricing, subrogation and more that have documented millions of dollars in savings.
Website: www.inetico.com
Optum Insight
Focus: Health Care Data
OptumInsight, Inc. develops software and information products and provides advisory consulting service and business process outsourcing to participants in the health care industry. The company serves hospitals, physicians, commercial health plans, government agencies, life sciences companies, and other organizations that comprise the health care system work to reduce costs, meet compliance mandates, improve clinical performance, and adapt to the changing health system landscape. OptumInsight, Inc. serves physicians, hospitals.
Website: www.optum.com
WEX Health
Focus: Spending Account Administration
About WEX Health
We simplify the business of healthcare through WEX Health Cloud, a cloud-based healthcare financial management platform that drives efficiency for benefit administration technology, consumer engagement, and advanced billing and payments. Our partner organizations enable us to deliver our industry-leading and award-winning solution to 225,000 employers and more than 24 million consumers. Together we take the complexity out of defined contribution, HSAs, HRAs, FSAs, VEBAs, PRAs, premium billing, public and private health insurance exchanges, COBRA, wellness plans, and transit plans. Learn more at www.wexhealthinc.com, and follow WEX Health at @WEXHealthInc.
