PAYER SOLUTIONS

CORE ADMINISTARTION SOLUTION

Your core administration system is the foundation of your success, driving efficiency and helping ensure that your business is running well. Intuitive offers industry-leading core administration products—powerful, flexible enterprise software designed for payers of any size. These innovative solutions, Plexis™, automate business processes, increase efficiency and streamline workflows for greater productivity. With Intuitive healthcare IT solutions, you get the flexibility to conduct core administrative tasks today, while positioning your organization for the additional functionality and product integration that you’ll need for success in tomorrow’s healthcare industry.

Regardless of the markets you serve, our core administration systems allow you to administer plans across all lines of business including Commercial, Individual / Small Group, Vision, Dental, Specialty and Consumer-Directed.

CLAIMS MANAGEMENT SOFTWARE

Domestic and international healthcare payers are increasingly gaining significant cost-savings and ROI by replacing legacy claims systems. Widespread problems with the old technology include a lack of analytics and collaboration, increasing regulations, new business models, and rising customer expectations. Businesses are showing increasing enthusiasm for technology and automated software, spurring investment in new products that enhance productivity and customer service.

 

 

 

 

 

 

 

 

COST CONTAINMENT

Payers leverage the INTUITIVE platform to successfully control expenses

While healthcare costs have risen dramatically over the past decade, cost containment organizations are successfully leveraging INTUITIVE’ proven payer platform to reduce the utilization and cost of unnecessary health services. A growing number of payers are utilizing INTUITIVE’ integrated clinical, financial, and administrative platform to replace a legacy system or stand-up a new line of business. The INTUITIVE platform empowers effective care management, PPO repricing, business intelligence, and automated efficiencies to help enhance quality of care and patient outcomes while significantly reducing utilization and costs.

CARE MANAGEMENT

INTUITIVE understands the need to capture and aggregate data in order to identify and manage medical cases and health conditions. Whether payers are involved with the expanding PCMH model or other quality of care initiatives, INTUITIVE offers a care management solution. This solution can deliver data and resources to enable proactive engagement with providers, ultimately reducing costs and improving quality of care.

 

 

 

 

 

 

 

 

CUSTOMER SERVICE FOR PAYERS

In today’s world of data-on-demand, healthcare payers are increasingly learning that consumer expectations must drive payer operations. When it comes to delivering responsive, transparent customer service, the most successful payer organizations are taking the progressive step toward providing, monitoring, and ensuring that consumer engagement takes place consistently over the course of the customer journey.

As INTUITIVE Healthcare Systems has worked with payers over the past 19 years, we have honed our understanding of all payer markets, including Third Party Administrators, Health Plans, and International HMO organizations. The trends we have monitored since the beginning of the Affordable Care Act include the movement toward process efficiencies in payer-provider collaborations and the necessity of responsive customer service.

PORTALS

Extend your business to the stakeholders that matter

Our portal apps empower payers, providers, employers, and members to communicate more efficiently in today’s data-on-demand world.

INTUITIVE portal apps give members and providers the control, collaboration, and tools to be involved in the business of their healthcare. The result is a powerful and easy-to-use solution, built to lower your costs and adjudicate your claims faster and more efficiently.

Our web portal apps can be seamlessly integrated into our core administrative systems, giving you the tools to involve the stakeholders within your business ecosystem.

 

 

 

 

 

 

 

 

SALE + MARKETTING

Automating sales + marketing with INTUITIVE’ CRM capabilities

Drive prospects through the sales funnel to conversion

INTUITIVE can integrate Microsoft CRM functions within our core platform so that payers can drive sales from their existing customer base, capture new prospects, and greatly improve sales conversion rates.

Microsoft CRM can be leveraged for:

  • Harvesting actionable data from the sales funnel into a centralized platform
  • Segmenting your customer base and building organized lists
  • Automating email, lead, and follow-up campaigns
  • Targeting prospects with messaging specific to their segment, and converting them into engaged customers

EDI

Master orchestration and process execution for enterprise level solutions

Without a powerful EDI translator, manual data entry can use up valuable time and resources. INTUITIVE’ EDI apps deliver versatile gateway solutions, automating high volumes of EDI transactions with a customizable data conversion interface.

INTUITIVE’ EDI apps provide an innovative approach to delivering a flexible, scalable, data integration solution. Reduce administrative costs associated with enrollment and adjudication with the extensive functionality of our sophisticated XML-based EDI translator.

 

 

 

 

 

 

 

 

PREMIUM BILLING SOFTWARE

Eliminate manual data entry with premium billing software for medical, dental, vision, and more

In a changing healthcare industry, flexibility is the key to automating the premium billing administrative process. INTUITIVE’ automated, fully-featured premium billing capabilities include flexible billing options for premium calculations, billing frequency, and billing benefit types.

INTUITIVE empowers payers with medical premium billing, dental premium billing, and additional types of benefit administration including vision, life, and disability. INTUITIVE’ core administrative platforms offer an automated premium billing and accounts receivable system with options to define billing, receivables, and more.

ICD-10

Opportunities for new efficiencies and competitive differentiation

As the final date for ICD-10 compliance passes, payers continue to leverage INTUITIVE’ industry-leading claims management and benefit administration tools to turn ICD-10 compliance into an opportunity to increase operational efficiency and decrease MLR and a broad range of costs. INTUITIVE’ trusted, integrated clinical, financial, and administrative payer platform has incorporated ICD-10 coding since 2010.

For the past five years, INTUITIVE has helped take the worry out of the ICD-10 transition by offering progressive payer-provider collaboration tools and empowering payers to upgrade their core administrative technology. For the past 19 years, INTUITIVE has specialized in leveraging payers’ technological investments for not only a rapid ROI but also opportunities for significant organizational advantages and competitive differentiation. From streamlined electronic health record (EHR) capabilities to unbeatable auto-adjudication rates, INTUITIVE has you covered.