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AllMed Healthcare Management, AllMed Healthcare
Management is an independent review organization
(IRO) providing independent medical review and
hospital peer review services that improve
quality and patient safety.
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Benefit Informatics, Benefit Informatics is a leading healthcare data warehouse company serving
insurers, TPAs, broker/consultants, employers and employees/members. BI’s
proprietary web-based services integrate data from multiple claim and
eligibility sources and transform raw healthcare data into actionable management
information to allow all stakeholders in the employer health benefits continuum
to see the true costs of healthcare conveniently at their desktops.
Benefit Informatics provides simple and proven online tools, including
Data Analysis and Reporting, Plan Modeling and Forecasting and Benefit and
Wellness Communications to help self-funded employers and their administrators
manage, analyze and control healthcare costs. Through its payer clients
nationwide, Benefit Informatics currently serves more than 5,000 businesses and
health plans coordinating health benefits for more than 2 million members.
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HDM
Corp. founded in 1996, is a woman-owned Omaha-based company
dedicated to helping its nationwide clients find a better way to
administer health care transactions. HDM Corp. processes over 30
million health care transactions annually and seeks customized
solutions for its clients, whether they are payers
(insurance companies, TPAs, Taft-Hartley administrators, self-insured
employers and health plans) or providers.
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HMS is the
nation’s leader in cost management, coordination
of benefits, and program integrity services for
government healthcare programs. The company
serves the Medicaid programs of 40 states, 72
Medicaid managed care plans, the Centers for
Medicare and Medicaid Services (CMS), child
support agencies, SCHIP, and Veterans
Administration facilities. HMS helps ensure that
healthcare claims are paid correctly and by the
responsible party. As a result of the company’s
services, government healthcare programs recover
over $1.0 billion annually, and obtain access to
data that helps them save billions more. HMS has
offices nationwide.
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Innovative
Software Solutions, Inc. – ISSI is the
leading provider of Benefit Administration computer
systems in the Taft-Hartley Multi-employer
industry. Headquartered in Cherry Hill, NJ, ISSI
uses cutting edge technology and over 25 years of
industry experience to service and support every
facet of Benefit Fund Administration. ISSI systems
are used by more than 250 Benefit Fund Offices and
Third Party Administrators (TPA's) in the U.S. and
Canada.
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Medical Excess, LLC
is a leading provider of stop loss products, organ transplant coverages and
catastrophic medical products. As a member company of AIU, Medical Excess can
underwrite business in all 50 states and place it with financially strong
insurers.
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MEDInnovation®
– A comprehensive suite of capabilities providing real solutions and much
needed risk management tools to the employer community through select Claims
Payers, and their broker/consultant relationships. Medical Excess, with
their partner TC³ Health and MedStat, deliver these capabilities through
MEDInnovation®. These services are leveraged by a high integrity data
platform that is the foundation for MEDInnovation®. This allows Self
Funded Employers to apply true Risk Management strategies to their
program. This platform allows MEDInnovation® to deliver continuous
development of best in class capabilities. |
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NationsRx
- NationsRx, LLC is a pharmaceutical services organization designed to meet the
complex supply chain demands of today's healthcare payor and provider
entities. The NationsRx client base includes both payors (self insured
employers & government sponsored programs) and providers of care
including hospitals, health systems, home health providers (ambulatory infusion
services), ambulatory surgery centers, long-term care pharmacy providers, PBM
mail order pharmacies and government sponsored healthcare delivery channels
(VA, DoD, State Facilities, PHS). |
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NCN
is the national leader in cost management for out-of-network claims. In today’s
healthcare landscape, traditional negotiating techniques and supplemental
networks have become less effective in managing medical costs. NCN has developed
a unique new claims evaluation process that maximizes savings in a manner that
is transparent, defensible and repeatable. Our investment in patent-pending
methodology, combined with our commitment to act as a partner to our clients,
results in substantial reductions in healthcare costs for our clients.
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NHCAA
- The National Health Care Anti-Fraud Association was founded in 1985 by
several private health insurers together with Federal and state law enforcement
officials. Headquartered in Washington, D.C., NHCAA is a unique, issue-based
non-profit organization built upon the private-public partnership of
organizations and individuals responsible for the detection, investigation,
prosecution, and prevention of fraud against private and public health
insurance plans. NHCAA serves its members and the anti-fraud community at-large
by offering unmatched education and training opportunities to private- and
public-sector health care anti-fraud personnel through the NHCAA Institute for
Health Care Fraud Prevention, a separately incorporated, tax-exempt educational
foundation. Each year, NHCAA's education and training opportunities are hosted
throughout the country, culminating at the Annual Training Conference in
November. This is the association's largest event of the year, regularly
attended by more than 1,000 industry professionals. In addition, NHCAA provides
a unique venue for information-sharing and collaboration among its more than
125 Member Organizations and Law Enforcement Liaisons to assist in the fight
against health care fraud. Serving consumers is also central to the NHCAA
Mission: To protect and serve the public interest by increasing awareness and
improving the detection, investigation, civil and criminal prosecution and
prevention of health care fraud. |
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SunGard Relius
- iWORKS GBAS provides group health
claims and benefit administration solutions for insurance companies, third party
administrators, and self-administered employers. Eligibility functionality
includes the ability to maintain enrollment information, process COBRA, bill and
collect premiums, and calculate and distribute payments to insurance carriers
and agents. Claims functionality includes the ability to set policy and provider
parameters, automatically adjudicate claims, and produce EOBs and claim
payments. Compliance with HIPAA, including transaction sets, is integrated into
the system. Web-based functionality includes the ability for employers,
employees and their dependents, and providers to view and interact securely with
relevant information maintained in the system. |
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Thomson Reuters
- Thomson Reuters provides market intelligence and benchmark
databases, decision support solutions, and research services for managing
healthcare costs and quality. |
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Trivium Health, Inc.
is a technological leader in medical and pharmacy
management information systems. Trivium meets the demands of today’s complex
healthcare environment by providing an effective pharmacy management program for
patients, providers, pharmacies, employers and regulators. Built on the IBM
Enterprise Content Management (ECM) suite of products, the Trivium solution,
TriviumRX, enables health information administrators to improve the speed,
quality, consistency and accuracy of prescription administration. |
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The TriZetto Group, Inc.
focuses on the business of healthcare and offers a broad portfolio of
technology products and services. TriZetto's customers serve more than 100
million health plan members, or approximately 40 percent of the insured
population of the United States.
TriZetto also offers a portfolio of specialized software components that provide
expanded functionality for specific business cycles and can be used as key
components for supporting payers' consumer-focused strategies.
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