Health plans & technology hotlist.

Health Plans & Technology HotList

Company                     Affiliated Network     Amisys Synertech
                                 Service                 Inc.

RSLeads Number               www.rsleads.com/      www.rsleads.com/
                                504ht-227              504ht-228

Product Name                    ANSDIRECT           AMISYS ADVANCE

Target Market                Health insurers       Healthcare payers

Electronic claims                  yes                    yes
submission
Claims accumulators                 no                    yes
to track benefit usage
Claims Mgt. review                  no                    yes
Claims adjudication logic           no                    yes
Claims grouping by                  no                    yes
episode of care
Claims/code editing                yes                    yes
Internet functions                 yes                    yes
Customer service tracking           no                    yes
Regulation compliance               no                    yes
Case mix and/or Mgt.                no                    yes
Provider credentialing              no                    yes
Outcomes measurements               no                    yes
HEDIS reporting                     no                    yes
Quality assessment                  no                    yes
Utilization Mgt.                    no                    yes
Physician peer review               no                    yes
Maintains provider                  no                    yes
profiles
Risk adjustment                     no                    yes
Referral Mgt./tracking              no                    no
Employer group reporting            no                    yes
Eligibility verification/          yes                    yes
tracking
Benefit plan definition             no                    yes
Contract modeling/                  no                    yes
projection
Maintains premium                   no                    yes
rate tables
Payment tracking-                   no                    yes
contracts/subcontracts
Online interface to                 no                    yes
patient accounting system
Maintains capitation rate           no                    yes
tables
Premium billing                     no                    yes
Decision support                    no                    yes

Company                        ChangeArtist       Concentra Preferred
                                                        Systems

RSLeads Number               www.rsleads.com/      www.rsleads.com/
                                 5001-229              504ht-230

Product Name                  MCO FUNCTIONAL      CLAIMS TRANSACTION
                               SPECS. LIST               MGT.

Target Market               Health plans, COs      Carriers, Blues
                                                      plans, TPAs

Electronic claims                   no                    no
submission
Claims accumulators                 no                    no
to track benefit usage
Claims Mgt. review                  no                    yes
Claims adjudication logic           no                    no
Claims grouping by                  no                    yes
episode of care
Claims/code editing                 no                    yes
Internet functions                 yes                    yes
Customer service tracking           no                    yes
Regulation compliance               no                    no
Case mix and/or Mgt.                no                    no
Provider credentialing              no                    no
Outcomes measurements              yes                    yes
HEDIS reporting                     no                    yes
Quality assessment                 yes                    no
Utilization Mgt.                   yes                    yes
Physician peer review               no                    yes
Maintains provider                  no                    no
profiles
Risk adjustment                     no                    no
Referral Mgt./tracking              no                    yes
Employer group reporting           yes                    no
Eligibility verification/           no                    no
tracking
Benefit plan definition             no                    no
Contract modeling/                  no                    yes
projection
Maintains premium                   no                    no
rate tables
Payment tracking-                   no                    no
contracts/subcontracts
Online interface to                 no                    no
patient accounting system
Maintains capitation rate           no                    no
tables
Premium billing                     no                    no
Decision support                   yes                    yes

Company                       CPM Marketing            DataLoom
                                Group Inc.          Solutions Inc.

RSLeads Number               www.rsleads.com/      www.rsleads.com/
                                504ht-231              504ht-232

Product Name                  DSS WORKBENCH          HEALTHWEAVER

Target Market                  Health plans       Healthcare industry

Electronic claims                   no                    no
submission
Claims accumulators                 no                    no
to track benefit usage
Claims Mgt. review                  no                    yes
Claims adjudication logic           no                    no
Claims grouping by                  no                    yes
episode of care
Claims/code editing                 no                    yes
Internet functions                 yes                    yes
Customer service tracking           no                    no
Regulation compliance               no                    no
Case mix and/or Mgt.                no                    no
Provider credentialing              no                    no
Outcomes measurements              yes                    no
HEDIS reporting                     no                    yes
Quality assessment                 yes                    yes
Utilization Mgt.                   yes                    no
Physician peer review               no                    yes
Maintains provider                  no                    yes
profiles
Risk adjustment                     no                    no
Referral Mgt./tracking             yes                    no
Employer group reporting           yes                    no
Eligibility verification/           no                    no
tracking
Benefit plan definition             no                    no
Contract modeling/                  no                    no
projection
Maintains premium                   no                    yes
rate tables
Payment tracking-                   no                    no
contracts/subcontracts
Online interface to                 no                    no
patient accounting system
Maintains capitation rate           no                    no
tables
Premium billing                     no                    no
Decision support                   yes                    yes

Company                      E*HealthLine.Com     FACTS Services Inc.
                                   Inc.

RSLeads Number               www.rsleads.com/      www.rsleads.com/
                                504ht-233              504ht-234

Product Name                     ETERNITY                FACTS

Target Market               Health plan, MSOs      Healthcare payers

Electronic claims                  yes                    yes
submission
Claims accumulators                yes                    yes
to track benefit usage
Claims Mgt. review                 yes                    yes
Claims adjudication logic          yes                    yes
Claims grouping by                 yes                    yes
episode of care
Claims/code editing                yes                    yes
Internet functions                 yes                    yes
Customer service tracking           no                    no
Regulation compliance              yes                    yes
Case mix and/or Mgt.               yes                    yes
Provider credentialing             yes                    yes
Outcomes measurements              yes                    yes
HEDIS reporting                    yes                    yes
Quality assessment                 yes                    no
Utilization Mgt.                   yes                    yes
Physician peer review              yes                    no
Maintains provider                 yes                    yes
profiles
Risk adjustment                    yes                    yes
Referral Mgt./tracking             yes                    yes
Employer group reporting           yes                    yes
Eligibility verification/          yes                    yes
tracking
Benefit plan definition            yes                    yes
Contract modeling/                 yes                    yes
projection
Maintains premium                  yes                    yes
rate tables
Payment tracking-                  yes                    yes
contracts/subcontracts
Online interface to                yes                    no
patient accounting system
Maintains capitation rate          yes                    yes
tables
Premium billing                    yes                    yes
Decision support                   yes                    yes

Company                       Health Access       HealthLine Systems
                                Solutions

RSLeads Number               www.rsleads.com/      www.rsleads.com/
                                 504-235               504ht-236

Product Name                  ACCESS EXPRESS             ECHO

Target Market               MSOs, IPAs, Health       Health plans,
                                  plans               MCOs, IDNs

Electronic claims                   no                    no
submission
Claims accumulators                 no                    no
to track benefit usage
Claims Mgt. review                 yes                    no
Claims adjudication logic           no                    no
Claims grouping by                  no                    no
episode of care
Claims/code editing                 no                    no
Internet functions                 yes                    yes
Customer service tracking          yes                    yes
Regulation compliance               no                    yes
Case mix and/or Mgt.               yes                    no
Provider credentialing              no                    yes
Outcomes measurements               no                    yes
HEDIS reporting                     no                    no
Quality assessment                  no                    yes
Utilization Mgt.                   yes                    yes
Physician peer review               no                    yes
Maintains provider                 yes                    yes
profiles
Risk adjustment                     no                    no
Referral Mgt./tracking             yes                    no
Employer group reporting            no                    yes
Eligibility verification/          yes                    no
tracking
Benefit plan definition            yes                    no
Contract modeling/                  no                    no
projection
Maintains premium                   no                    no
rate tables
Payment tracking-                  yes                    yes
contracts/subcontracts
Online interface to                 no                    no
patient accounting system
Maintains capitation rate           no                    yes
tables
Premium billing                     no                    no
Decision support                   yes                    no

Company                     Health Mgt. Corp.         HealthTrio

RSLeads Number               www.rsleads.com/      www.rsleads.com/
                                504ht-237              504ht-238

Product Name                   DISEASE MGT.       EXPRESS AND CONNECT

Target Market                 Health plans,       Health plans, IPAs,
                                 Medicaid              PHOs,MSOs

Electronic claims                   no                    yes
submission
Claims accumulators                 no                    yes
to track benefit usage
Claims Mgt. review                  no                    yes
Claims adjudication logic           no                    yes
Claims grouping by                  no                    yes
episode of care
Claims/code editing                 no                    yes
Internet functions                 yes                    yes
Customer service tracking          yes                    yes
Regulation compliance               no                    yes
Case mix and/or Mgt.                no                    yes
Provider credentialing              no                    yes
Outcomes measurements              yes                    yes
HEDIS reporting                    yes                    no
Quality assessment                  no                    yes
Utilization Mgt.                    no                    yes
Physician peer review               no                    yes
Maintains provider                  no                    yes
profiles
Risk adjustment                     no                    no
Referral Mgt./tracking             yes                    yes
Employer group reporting           yes                    yes
Eligibility verification/           no                    yes
tracking
Benefit plan definition             no                    yes
Contract modeling/                  no                    yes
projection
Maintains premium                   no                    yes
rate tables
Payment tracking-                   no                    yes
contracts/subcontracts
Online interface to                 no                    yes
patient accounting system
Maintains capitation rate           no                    yes
tables
Premium billing                     no                    yes
Decision support                   yes                    yes

Company                          HSS Inc.              McKesson

RSLeads Number               www.rsleads.com/      www.rsleads.com/
                                504ht-239              504ht-240

Product Name                     WINSTRAT             CRMS, CCMS,
                                                       INTERQUAL

Target Market               Managed care org.      Payers/providers

Electronic claims                   no                    no
submission
Claims accumulators                 no                    no
to track benefit usage
Claims Mgt. review                 yes                    no
Claims adjudication logic          yes                    no
Claims grouping by                 yes                    no
episode of care
Claims/code editing                yes                    yes
Internet functions                 yes                    yes
Customer service tracking          yes                    no
Regulation compliance              yes                    yes
Case mix and/or Mgt.               yes                    yes
Provider credentialing              no                    no
Outcomes measurements              yes                    yes
HEDIS reporting                     no                    yes
Quality assessment                  no                    yes
Utilization Mgt.                    no                    yes
Physician peer review               no                    yes
Maintains provider                 yes                    yes
profiles
Risk adjustment                    yes                    yes
Referral Mgt./tracking              no                    no
Employer group reporting            no                    yes
Eligibility verification/           no                    yes
tracking
Benefit plan definition             no                    yes
Contract modeling/                 yes                    yes
projection
Maintains premium                  yes                    no
rate tables
Payment tracking-                   no                    no
contracts/subcontracts
Online interface to                yes                    no
patient accounting system
Maintains capitation rate           no                    no
tables
Premium billing                     no                    no
Decision support                    no                    yes

Company                      MEDecision Inc.        NaviMedix Inc.

RSLeads Number               www.rsleads.com/      www.rsleads.com/
                                504ht-241              504ht-242

Product Name                INTEGRATED MEDICAL          NAVINET
                                   MGT.

Target Market               Managed care org.        Health plans

Electronic claims                   no                    yes
submission
Claims accumulators                 no                    no
to track benefit usage
Claims Mgt. review                  no                    yes
Claims adjudication logic          yes                    yes
Claims grouping by                 yes                    yes
episode of care
Claims/code editing                 no                    yes
Internet functions                 yes                    yes
Customer service tracking           no                    no
Regulation compliance               no                    yes
Case mix and/or Mgt.               yes                    yes
Provider credentialing              no                    yes
Outcomes measurements              yes                    yes
HEDIS reporting                     no                    yes
Quality assessment                 yes                    no
Utilization Mgt.                   yes                    yes
Physician peer review               no                    no
Maintains provider                 yes                    yes
profiles
Risk adjustment                    yes                    yes
Referral Mgt./tracking             yes                    no
Employer group reporting           yes                    no
Eligibility verification/          yes                    yes
tracking
Benefit plan definition             no                    yes
Contract modeling/                  no                    yes
projection
Maintains premium                   no                    no
rate tables
Payment tracking-                   no                    yes
contracts/subcontracts
Online interface to                 no                    yes
patient accounting system
Maintains capitation rate           no                    yes
tables
Premium billing                     no                    yes
Decision support                   yes                    yes

Company                     Perot Systems Corp.      Personable PC
                                                       Solutions

RSLeads Number               www.rsleads.com/      www.rsleads.com/
                                504ht-243              504ht-244

Product Name                  PAYER PERADIGM           CAP CHECK

Target Market                Health insurers       IPAs, MSOs, TPAs

Electronic claims
submission                         yes                    no
Claims accumulators
to track benefit usage             yes                    yes
Claims Mgt. review
Claims adjudication logic          yes                    no
Claims grouping by                 yes                    no
episode of care                    yes                    no
Claims/code editing
Internet functions                 yes                    no
Customer service tracking           no                    yes
Regulation compliance              yes                    yes
Case mix and/or Mgt.               yes                    no
Provider credentialing              no                    no
Outcomes measurements              yes                    no
HEDIS reporting                     no                    no
Quality assessment                  no                    no
Utilization Mgt.                    no                    no
Physician peer review               no                    no
Maintains provider                 yes                    no
profiles                            no                    no
Risk adjustment
Referral Mgt./tracking             yes                    no
Employer group reporting            no                    yes
Eligibility verification/          yes                    no
tracking                           yes                    no
Benefit plan definition
Contract modeling/                 yes                    no
projection                         yes                    no
Maintains premium
rate tables                        yes                    yes
Payment tracking-
contracts/subcontracts             yes                    no
Online interface to
patient accounting system          yes                    no
Maintains capitation rate
tables                             yes                    no
Premium billing
Decision support                   yes                    yes
                                   yes                    no

Company                     Plexis Healthcare            QCSI
                                 Systems

RSLeads Number               www.rsleads.com/      www.rsleads.com/
                                504ht-245              504ht-246

Product Name                  PLEXIS CLAIMS              QNXT
                                 MANAGER

Target Market               Health plans, TPAs,         Payers
                                PPOs, IPAs

Electronic claims                  yes                    yes
submission
Claims accumulators                yes                    yes
to track benefit usage
Claims Mgt. review                 yes                    yes
Claims adjudication logic          yes                    yes
Claims grouping by                 yes                    no
episode of care
Claims/code editing                yes                    yes
Internet functions                 yes                    yes
Customer service tracking           no                    yes
Regulation compliance              yes                    yes
Case mix and/or Mgt.               yes                    yes
Provider credentialing             yes                    yes
Outcomes measurements              yes                    no
HEDIS reporting                    yes                    no
Quality assessment                 yes                    yes
Utilization Mgt.                   yes                    no
Physician peer review               no                    no
Maintains provider                 yes                    no
profiles
Risk adjustment                    yes                    yes
Referral Mgt./tracking             yes                    yes
Employer group reporting           yes                    yes
Eligibility verification/          yes                    yes
tracking
Benefit plan definition            yes                    yes
Contract modeling/                 yes                    yes
projection
Maintains premium                  yes                    yes
rate tables
Payment tracking-                  yes                    yes
contracts/subcontracts
Online interface to                yes                    yes
patient accounting system
Maintains capitation rate          yes                    yes
tables
Premium billing                    yes                    yes
Decision support                   yes                    no

Company                      RAM Technologies       TCS Healthcare
                                   Inc.                  Tech.

RSLeads Number               www.rsleads.com/      www.rsleads.com/
                                504ht-247              504ht-248

Product Name                   HEALTHSUITE              ACUITY

Target Market                  Health plans       Health plans, TPAs

Electronic claims                  yes                    no
submission
Claims accumulators                yes                    no
to track benefit usage
Claims Mgt. review                 yes                    no
Claims adjudication logic          yes                    no
Claims grouping by                 yes                    no
episode of care
Claims/code editing                yes                    no
Internet functions                 yes                    no
Customer service tracking           no                    no
Regulation compliance              yes                    no
Case mix and/or Mgt.               yes                    yes
Provider credentialing             yes                    no
Outcomes measurements               no                    yes
HEDIS reporting                     no                    no
Quality assessment                  no                    yes
Utilization Mgt.                   yes                    yes
Physician peer review               no                    no
Maintains provider                 yes                    no
profiles
Risk adjustment                    yes                    no
Referral Mgt./tracking             yes                    yes
Employer group reporting           yes                    yes
Eligibility verification/          yes                    no
tracking
Benefit plan definition            yes                    no
Contract modeling/                 yes                    no
projection
Maintains premium                  yes                    no
rate tables
Payment tracking-                  yes                    no
contracts/subcontracts
Online interface to                 no                    no
patient accounting system
Maintains capitation rate          yes                    no
tables
Premium billing                    yes                    no
Decision support                   yes                    yes

Company                       TriZetto Group

RSLeads Number               www.rsleads.com/
                                504ht-249

Product Name                    FACETS E2

Target Market                     Payers

Electronic claims                  yes
submission
Claims accumulators                yes
to track benefit usage
Claims Mgt. review                 yes
Claims adjudication logic          yes
Claims grouping by                 yes
episode of care
Claims/code editing                yes
Internet functions                 yes
Customer service tracking           no
Regulation compliance              yes
Case mix and/or Mgt.               yes
Provider credentialing             yes
Outcomes measurements               no
HEDIS reporting                     no
Quality assessment                  no
Utilization Mgt.                   yes
Physician peer review               no
Maintains provider                 yes
profiles
Risk adjustment                    yes
Referral Mgt./tracking             yes
Employer group reporting           yes
Eligibility verification/          yes
tracking
Benefit plan definition            yes
Contract modeling/                 yes
projection
Maintains premium                  yes
rate tables
Payment tracking-                  yes
contracts/subcontracts
Online interface to                yes
patient accounting system
Maintains capitation rate          yes
tables
Premium billing                    yes
Decision support                   yes