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EIS Group (San Francisco), a provider of core software systems to insurers, has released latest version of its ClaimCore claims management solution. The new version supports claims for dental insurance and is designed to enable benefits insurers to reduce costs through improved dental claims accuracy, efficiency, and auto-adjudication, and to support growth through enhanced digital self-service to employers, claimants, and providers.
The latest release of ClaimCore aims to help dental insurers to modernize and fully digitize their operations, according to the vendor. EIS Group describes ClaimCore as a complete dental claim system built on modern and configurable technology to support DHMO and PPO products in both group and individual markets. The vendor says that ClaimCore for dental claims has been deployed at one large, U.S.-based benefits insurer and being evaluated by additional carriers.
Simplified User Interfaces, Omnichannel Engagement Support
EIS Group reports that ClaimCore is designed to accurately and quickly process dental claims by enabling no-touch auto-adjudication via a comprehensive set of business rules, by delivering high-quality digital experiences through simplified user interfaces and omnichannel engagement support, and leveraging its integration capabilities to easily connect with policy and billing systems, provider networks and other data sources.
ClaimCore for dental claims provides insurers the following advantages as described by the vendor:
- A single comprehensive claim solution—ClaimCore simplifies operations by introducing a single solution that replaces disparate technologies, including claims calculation, fee schedules, payment, workflow and document imaging solutions, to deliver accuracy and consistency to the dental claims process.
- A flexible and configurable rules engine—ClaimCore enables no-touch auto-adjudication to accurately compare claims against provider networks, patient history, and coverage parameters to increase auto adjudicated claims throughput while also monitoring and measuring rule use.
- Streamlined claim intake—Intuitive workflows and mouse-free navigation of claim intake for high-speed, high-volume keying of data improves the system user experience and productivity.
- Digital ready solution—ClaimCore is fully digital business enabled through an extensive API portfolio and is pre-integrated to the EIS DXP digital experience platform for the delivery of omnichannel engagement that includes configurable mobile and online apps and portals.
ClaimCore can be deployed as a standalone core system or as a modular component of EIS Core Insurance Suite, which the vendor says provides benefits insurers with additional options for transforming their legacy core systems. When deployed as part of the pre-integrated EIS Suite—comprising PolicyCore, BillingCore, ClaimCore and CustomerCore—eligibility, coverages and customer information are immediately available to claims operations, the vendor reports.
“We are very pleased to offer this superior dental claim management solution option to address the process inefficiencies and eligibility issues that can negatively impact claims customer service and increase expense for insurers,” comments Jim Eva, EIS Group’s product executive for claims. “We have applied the design flexibility and digital readiness of the EIS platform to create a solution that works seamlessly within the EIS Suite or as a standalone component to deliver better claims outcomes.”