Ebix FACTS

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.

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

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.

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.

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

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

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

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

Streamlines claim processing with automated workflow distribution to adjusters.

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

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

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

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

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

Automated generation of letters related to claims and benefits.

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

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

Automated system for managing provider capitation and sub-capitation.

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

Administration of Point-of-Service plans.

Automated system for managing PCP credentials and relationships.

Automated case management system for tracking and managing patient care.

Enables efficient claim data entry and filing for later processing.

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

Automated routing of claims to adjuster work queues.

User-friendly tool for creating custom reports.

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

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

Supports various hardware options (Windows to Unix).

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

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

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

Networking and educational opportunities for FACTS® users.

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