Ebix FACTS

Additional features

Multi-Line of Business Support

Supports 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) within a single, unified system.

Claim and Encounter Processing

Automated, real-time processing of medical, dental, vision, prescription drug, disability, and COBRA claims and encounters, including online adjudication.

Managed Care Administration

Tools for provider network management (including unlimited contracts and providers per PPO), provider capitation management, pre-authorization, utilization review (UR), utilization management (UM), physician referrals, point of service (POS) administration, primary care physician (PCP) profiling and credentialing, and case management.

Policy/Benefit Administration

Fully automated benefit administration with support for eligibility, billing, collections, and commissions, accommodating both group and individual plans, as well as life and AD&D coverage.

HIPAA Compliance

Built-in HIPAA compliant solutions and infrastructure, ensuring adherence to regulations.

Web and Voice-Enabled Access

24/7 interactive access to claims and benefit information, and real-time transactions (including EDI claim uploads) through the internet and voice-based systems.

Automatic Claim Adjudication

Parameter-driven, automated claim adjudication with minimal adjuster intervention.

Electronic Data Interchange (EDI)

Facilitates electronic claim submission and data exchange with providers and clearinghouses.

Electronic Claim Workflow

Streamlines claim processing with automated workflow distribution to adjusters.

Claim Processing/Pre-processing

Allows for efficient claim data entry and pre-processing before authorization.

Automatic Claim Coding

Automated claim coding based on claim parameters and industry-defined templates.

Optical Imaging/IOCR

Integrated system for document imaging, scanning, storage, and retrieval, enabling faster processing of paper claims.

MICR Laser Check/EOB Encoding

Laser printing of checks with Explanation of Benefits (EOBs) including logos, signatures, and MICR encoding.

Standard/Custom Report Generation

Provides flexible reporting capabilities with both pre-defined and user-customizable reports.

Letter Generation

Automated generation of letters related to claims and benefits.

Clinical Editing and Auditing

Online, interactive claim editing and auditing using Ingenix™ database to verify coding and identify potential issues.

Provider Network Management

Comprehensive provider database management with support for multiple contracts, PPOs, and providers.

Provider Capitation Management

Automated system for managing provider capitation and sub-capitation.

Pre-Authorization, UR, UM, and Physician Referrals

Automated system for managing pre-authorizations, utilization review, utilization management, and physician referrals.

Point of Service (POS)

Administration of Point-of-Service plans.

Primary Care Physician Profiling and Credentialing

Automated system for managing PCP credentials and relationships.

Case Management

Automated case management system for tracking and managing patient care.

Claims Pre-Processing

Enables efficient claim data entry and filing for later processing.

Automatic Claim Coding

Automated claim coding based on claim parameters and industry-defined templates.

Electronic Claim Workflow Distribution

Automated routing of claims to adjuster work queues.

Custom Report Generator

User-friendly tool for creating custom reports.

Real-time, Internet Based Access (FACTS®Web™)

Secure, 24/7 web access to claim, coverage, and benefit information.

Real-time, Telephony Based Access (FACTS® IVR™)

Interactive voice response system for accessing benefits and claim status information via phone.

Hardware Solutions

Supports various hardware options (Windows to Unix).

Full-Service Support

Includes implementation, training, data conversion, software maintenance, phone/online/modem support, and custom programming.

Professional Services

Consultation and assistance for software, hardware, implementations, and network services.

Education & Training

Extensive training programs, including on-site and in-office options.

User Group Conference

Networking and educational opportunities for FACTS® users.

Partnerships

Integrates with various third-party solutions (Captiva, Emdeon, Ingenix, National Care Network, SourceLynx, Alegeus, Avnet, Dell, Discovery Benefits, Infinisource, HP, IBM, Microsoft, TigerLogic).