End-to-end claims
automation.
A robust platform designed to automate and simplify health and voluntary benefits claims administration. Significantly increases automation, lowers costs, and increases efficiency without compromising accuracy or compliance.
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Beyond basic claims processing
With integrated medical and financial management, EbixEnterprise Claims goes well beyond basic processing. Built-in tools for utilization, case, and disease management ensure better care coordination and cost control.
Advanced billing, financial management, and a comprehensive reporting suite deliver real-time insights to drive smarter and quicker decisions across all major lines of business.
A smarter way to manage claims
A single, scalable solution that brings together automation, accuracy, medical oversight, and compliance, all in one place. Lower administrative costs, faster processing, and an improved experience for clients, members, and providers.
Efficiency, accuracy, and compliance
Document management workflow
Integrated document imaging for fast, secure access to claims documentation. Electronic workflow streamlines processing, reduces manual touchpoints, and supports efficient customer service.
Financial management
Accounting-based core ensures accurate claims and premium reconciliation. Consolidated billing for group and individual coverage with EFT for secure, timely payments.
Plan flexibility & auditing
Unlimited configuration of benefit plans with detailed auditing capabilities for transparency and internal controls. Customizable EOBs with web-based delivery.
Medical management & compliance
Complete medical management: utilization review, case management, and disease management. Government compliance tools and fully HIPAA-compliant EDI solution.
Auto-adjudication engine
Auto-adjudication with full claim lifecycle management: eligible claims are processed automatically based on configured rules, reducing manual intervention and improving turnaround time and accuracy.
Reporting & analytics
Real-time insight into claims trends, financial performance, and operational efficiency, backed by a reporting suite with 400+ built-in reports.
Claims efficiency for carriers and payers
Automate the entire claims lifecycle, from intake to adjudication and payment, with built-in fraud detection, utilization management, and government compliance.
Automated claims lifecycle
From intake to adjudication and payment: faster, more accurate processing with built-in fraud detection.
Regulatory compliance
Government regulations, HIPAA compliance, and ICD-10 readiness built in, reducing legal risk.
Real-time analytics
Actionable insights into claims trends, financial performance, and operational efficiency.
Cost control
Utilization review, case management, and disease management to identify unnecessary care and reduce costs.
Fraud prevention
Detailed auditing and fraud detection tools minimize risk and maintain integrity.
Scalability
Unlimited benefit plans, from individual to group, without needing separate systems.
Scalable claims administration for TPAs
A flexible, high-performance system that simplifies complex workflows while ensuring accuracy and compliance. Streamlines claims processing, automates benefit administration, and integrates medical management, billing, and reporting.
Automated adjudication and electronic workflows reduce manual intervention for faster turnarounds.
Health, dental, vision, HRA, HSA: manage accounting, billing, and claims in a single platform.
Electronic family files, customizable EOBs, and real-time reporting for superior client service.
Add clients and benefit plans without overhauling infrastructure, and adapt to market changes quickly.
Claims connects to the broader platform
Claims Administration works alongside the broader EbixEnterprise operating model, connected to the systems and experiences it depends on.
Strengthen your
claims operations
For organizations that want stronger claims efficiency, clearer operational visibility, and a more connected administrative foundation.