Our EIXSYS 360 solution includes the following portals and apps:
Consumer Enrollment Portal: Allows consumers to obtain real-time quotes, along with a reference number to be conveniently used during the enrollment process. This portal ensures a seamless enrollment process for the consumer and the carrier.
Benefits of this portal include:
-Higher consumer satisfaction, as they can obtain quotes instantly, resulting in higher overall enrollment for the plan.
-Reduction in error, as the reference number provided to the member is linked directly to his or her information to be used during enrollment.
-Convenience for the consumer and the carrier, as the consumer’s payment information is securely stored for the purpose of paying premiums monthly. Once the members information is entered into this portal, 834 and 820 EDI files are created automatically and their information is stored and available to the healthcare plan.
-Generates leads for the carrier.
Employer Portal: A self-service solution for employers to learn about product offerings and to obtain real-time quotes. This portal allows employers to select the right plan for their company and provides the capability to fully manage that plan.
Benefits of this portal include:
-Control, as this portal allows employers full access to their health plan. They are able to enroll or dis-enroll employees or their dependents on the portal, eliminating the need for a phone call.
-Convenience for the employer and the carrier, as the employer’s payment information is securely stored for the purpose of paying premiums monthly. Once the employers information is entered into this portal, 834 and 820 EDI files are created automatically and their information is stored and available to the healthcare plan.
Broker Portal: Streamlines new sales for insurance brokers by using a simplified approach with full access to plan product information, forms, and real-time quotes for individuals or groups. This portal tracks commission payments as well, providing commission statements to both brokers and carriers.
Benefits of this portal include:
-Time management, as this portal allows brokers the ease of enrolling and dis-enrolling members.
-Commission tracking, for both the broker and the carrier, ensures brokers are paid in a timely manner.
-Convenience for the broker and the carrier, as the member’s payment information is securely stored for the purpose of paying premiums monthly. Once the members information is entered into this portal, 834 and 820 EDI files are created automatically and their information is stored and available to the healthcare plan and broker.
-Verification made simple, as the broker can upload his or her license into the portal and the carrier can perform license verification as needed.
-Payment is simplified and automated. Brokers can upload a W-9 and voided check into the system, and carriers can auto pay the broker.
-Growth, as the ease this portal provides will encourage brokers to utilize the carrier more frequently.
Premium Portal: Electronic funds transfers are securely performed in this portal in order to allow automated premium payments. Insurance carriers can utilize this portal to generate A/R, aging, and other reports.
Benefits of this portal include:
-Convenience, as this portal is integrated into the broker, employer, and enrollment portals for the ease of all parties. Once the member’s information is automatically retrieved in the 820 EDI file format from the enrollment, employer, or broker portals, a bank ACH formatted file is generated, where their information is stored and made available.
-Time management, as the insurance carriers themselves can enroll and dis-enroll members directly from the premium portal.
Provider Directory: A list of in-network providers according to the NCQA, and their contact information is made accessible to members and other providers through this directory. When using our credentialing system, this information is automatically integrated, updating the directory.
Benefits of the Provider Directory include:
-Time management, as we can upload delegated credentialing, saving time and avoiding costly errors.
-Accuracy of referrals and authorizations, as providers can be accurately verified as an in-network provider prior to submission.
-Tracking of changes, as the provider directory is automatically updated anytime a provider changes information.
Provider Management Portal: A convenient way to track all provider enrollment needs, from managing leads, through the credentialing process, all the way to issuing a provider contract and ID. This user-friendly portal provides dashboards for convenient tracking.
Benefits of the Provider Management Portal include:
-Lead management, as this portal can track all provider leads, from member provider requests, to inbound call inquiries and applications from providers seeking to be in-network, to provider outreach, storing notes and providing status on each lead. This portal also includes a geolocation business directory for the convenience of locating physicians by zip code.
-Dashboard tracker, which provides status updates on all provider enrollment applications.
-Streamlines credentialing, as our system has features available that validates all provider documents and records, and performs inquiries on all physicians against the National Practitioner Data Bank. From this point, physicians are placed in either a category I file, which indicates no issues were found, or a category II file if issues were found, and sent to the committee review board for further investigation and final determination of acceptance.
-Contracting, a feature that once a physician is determined to be accepted into a carrier’s network, a contract is created and presented to the physician for signing. Upon submitting an executed provider contract, a provider ID is automatically issued and the provider’s information is then uploaded in the Provider Directory. Maintenance, which ensures all provider information is up to date and verifies that no new claims have been filed against the provider on the National Practitioner Data Bank.
-Disenrollment management, as if provider disenrollment occurs for any reason, he or she is automatically removed from the Provider Directory.
Administrative Portal: Serves as a reporting hub, providing a 360-degree view of the health plan from a statistical and administrative trend. Numerous reports can be generated from this portal, allowing for easy and accurate data tracking.
Benefits of the Administrative Portal include:
-Interoperability, as this portal provides easy access to all data throughout the carrier.
-Reporting made easy, as all reports can be run within this portal, including required reports for CMS and IRS. Examples of reports include number of current enrollees, amount paid in medical and prescription claims, and number of diagnostic and CPT codes submitted, just to name a few.
Provider Portal: Allows providers the ease and convenience of accessing pertinent information directly from their computer, eliminating the need for lengthy phone calls. This portal allows providers to check claim status, verify eligibility, and access a patient’s medial record if the patient grants permission through the member mobile app, and much more.
Benefits of the Provider Portal include:
-Tracking, as PCP’s can access a panel roster, verifying how many patients the provider has with that specific carrier.
-Improved health outcomes, as the provider is able to track through the panel roster the patient’s last date of service and preventative testing, including mammograms and physical exams, allowing for reminders to be sent to the patient. In addition, providers can track patient medication changes by accessing the patient’s medical record. Increases payer, member, and provider collaboration through eligibility verification, gap coverage alerts, accessibility to electronic medical records, claim status and remittance advice tracking, submittal of referrals and authorizations, and telemedicine through this portal.
Member Portal: Allows for efficient member re-enrollment and provides members full access to view and track all pertinent information. This portal is convenient for the consumer, as the login they used for the enrollment process is simply converted into the member portal, therefore no additional steps are required to create a user ID and password.
Benefits of the Member Portal include:
-Tracking, as a member can view his or her eligibility, claim status, authorization and referral status, current medications, and all information regarding dependents under the age of 18 years.
-Financial planning, as members can view benefit accumulators, such as how much has been met on their deductible, as well as view copayment amounts. In addition, this portal allows members to see how much they owe on their premiums and provides the option to pay them.
-Convenience, as this portal allows members the ease of accessing and changing information, such as updating medications and changing primary care providers on record.
Member Mobile App: This is a mobile app that is conveniently available on the patient’s phone. This app includes all of the features of the member portal, and more.
Benefits of the Member Mobile App include the following numerous additional features:
-Provider GPS, which allows the patient the convenience of locating a provider from their current location. When on vacation, one can easily search for the nearest in-network physician or urgent care to them through the use of GPS.
-Telemedicine, as this feature allows members the convenience of speaking with providers from the comfort of their own phone.
-Management of the Personal Health Record, as the patient can conveniently access his or her medical record and make necessary changes, such as change the PCP on record, update medication changes, add medical history, maintain immunization status, and share his or her encrypted record.
-Prescription formulary is available on this app for the convenience of searching for covered medications from the ease of the phone.
IVR System: Allows providers and members the convenience and ease of receiving automatic and after-hours service, without burdening the healthcare carrier’s system. Our IVR system eliminates the need for a costly phone call.
Benefits of the IVR System include:
-ID card processing, as this system holds requests for member ID cards.
-Enrollment status, as providers can call in to check the status of his or her enrollment.
-Claim status, which allows providers the convenience of tracking claims and pending amounts.
-Insurance verification, allowing providers the ability to instantly verify patient eligibility.
Call Center Portal: Eliminates the need for specialized departments within the carrier, as any resource can assist callers. With this portal, all portals can be accessed in order to assist members efficiently, which in turn, is cost effective for the carrier.
Benefits of the Call Center Portal include:
-Tracking, as a trace ID number is automatically populated for member and carrier convenience.
-Auditing, as all conversations are automatically recorded for auditing and tracking convenience for the carrier.
Prescription Formulary: Allows the display and estimated cost of covered medications, based upon the pharmacy benefit management program.
Benefits of the Prescription Formulary include:
-Search, as our prescription formulary has a built in dynamic search feature for the ease of members to either search or print a PDF of all drugs available on his or her plan.
-Convenience, as this feature is built into the member mobile app, eliminating the need for a carrier inquiry.
Website Development: Our IT team develops a website that works with all portals and allows the carrier to maximize workflow.
Telemedicine Application: This feature provides a real-time, secure, HIPAA compliant, cloud based video conferencing solution that allows interactive physician-to-patient visits.
Benefits of the Telemedicine Application include:
-Convenience, as this feature allows for patients to be seen by a provider from the comfort of their homes. In addition, patients can be seen after hours, eliminating the stress of missing work.
-Profitable for providers and carriers alike, as this feature helps boost overall revenue. Improves overall patient outcomes, as patients are more likely to reach out to be seen by a provider due to the convenience. No matter where the patients are located, they can simply pull up the telemedicine mobile app and be seen directly from their phone.
Data Warehouse: Stores data that has been collected from each portal and all claim sources, which is then integrated into the data warehouse. This approach facilitates a resolution of the interoperability crisis.Additionally, the collected data is structured to be formatted in EDI, FHIR, CCD and other formats, which is easily accessible at all times.
Benefits of using a data warehouse include:
-Increased efficiency, as optimization of business processes and data collection is made possible.
-Transcends the gap between data and business processes.
-Provides continuous centralized access control based on assigned roles, producing real-time reports generated from various complex conditions, measures, and variables.
Real-Time Interoperable Data Exchange (RIDE): A pre-designed data exchange gateway that communicates between portals, trading partners and the database server, in a secure self-hosted or cloud-hosted environment.
Benefits of using RIDE include:
-Error reduction and increased efficiency, as the need for manual input, reporting, and analysis of data is eliminated.
-Clinical outcome and overall population-level healthcare improvement due to real-time information sharing and trend analysis
-Improves patient safety, ensuring your system provides the best patient-care experience possible, as it provides access to more complete patient records.
-Increases accuracy of reporting data and trends, as interoperability allows for a steady-stream of data to populate into your system.
Health Information Exchange (HIE): Allows carriers to trade information about patients with other trading partners by using HL7, CCD, or FHIR formats, or any other preferred method of the parties. Examples of shared information include diagnostic and procedural codes, medications, and primary care physician information, just to name a few.
Benefits of the Health Information Exchange (HIE) include:
-Allows providers and payers alike a window into the complete patient record. Improves overall patient satisfaction and provider experience.
-Easy access to valuable clinical data.
-Achieves Meaningful use (MU) objectives.
Cloud Infrastructure: All data is stored on a cloud server. We offer a private cloud option, in which all data can be stored on our EIX server or on the health plan’s server, if preferred. Another option we offer is a Hybrid server option where data is hosted on the health plan’s server and the front-end portal is hosted on the EIX server simultaneously.
Benefits of using Cloud Infrastructure include:
-Fully managed IT services, which includes upgrades to servers and computer processing power, as well as up-to-date versions of software.
-Business continuity, as you can rest assured your data is protected through any crisis, including power outages and natural disasters. Being able to access your data quickly after crisis strikes, minimizes downtime and loss of productivity.
-Reduces operating costs.
-Flexibility, as the cloud allows you to connect to your business anywhere, anytime.
-Scalability, quickly allowing your business the flexibility to scale operation and storage needs up or down.
-Managed IT infrastructure.
Protected Health Information (PHI) De-identification Process: A way to provide internal information in a de-identified approach to external vendors and development teams, therefore protecting all patient data. Benefits of the PHI De-identification Process includes: Prevention of HIPAA violations and future breaches, which could potentially result in hefty fines, revoked licenses, and potential criminal liability. Convenience, as you can store de-identified data anywhere you want.
Attachment Management: An essential process that streamlines workflow to make your business more efficient. Carriers have repeatable processes fundamental to their successful daily operations. Our attachment process manager reduces the possibility of redundant attachments being stored in multiple locations.
Benefits of using Document Management include:
-Enhanced security, as access to attachments can be controlled and an audit trail is created of who viewed an attachment, when, and if any modifications were made. Improved collaboration, as attachments captured from different sources can now be accessed from multiple locations.
EDI Gateway: Allows for an exchange of information between trading partners to occur in an Electronic Data Interchange (EDI) format.This feature sends in-bound and out-bound health information in an X12 HIPAA mandated format.
Benefits of using EDI Gateway include:
-Lower transaction costs, as the need for paper, printing, filing, storage and postage are all eliminated.
-Built-in trading partner management, verifying the proper clearinghouse is sending the transaction.
-Compliance check is completed to ensure all data is submitted in a valid format.
-Speed, as an immediate, valid, 999-acknowledgement file is transmitted to the clearinghouse, listing all errors found.
CORE Infrastructure: An infrastructure that meets phases 1,2,3, and 4 of the CAQH CORE Committee requirements and standards. CAQH CORE has been designated by the Secretary of the Department of Health and Human Services (HHS) as the author for federally mandated operating rules per the Patient Protection and Affordable Care Act (ACA).
Benefits of CORE Infrastructure include:
-Meets the 2017 CMS launched administrative simplification pilot program, ensuring healthcare companies are in compliance with adopted standards and operating rules.
-Prevents non-compliant penalties to be enacted by the 21st Century Cures Act.
Trading Partner Management (TPM): An application that helps the carrier manage EDI business relationships with all trading partners. This feature allows carriers to easily configure parameters for the automated sending and receiving of messages from specified trading partners, while generating alerts if unauthorized users or unusual activity is detected.
Benefits of our Trading Partner Management application include:
-Cost containment, as administrative costs are reduced and operations are streamlined, reducing overall payer costs. Compliance is addressed and maintained in accordance with all regulations.
-Creates unique trading partner selection and governance. Security, as alerts are generated with detection of unusual or unauthorized activities.
Edge Server: Our self-hosted edge server assists carriers in remaining ACA compliant with CMS baseline and detail reporting requirements. We are the subject matter experts who follow the edge server business rules, while working closely with medical underwriters and actuaries to deliver Risk Adjustment and Reinsurance Program reporting.
Benefits of our Edge Server include:
-Meets all CMS required timelines, avoiding penalties, such as the risk adjustment default charge for insufficient data reporting.
IRS AIR Program Reporting: Our AIR Program Reporting generates 1095’s for individual members, carriers, and employers to be sent to IRS annually.
Benefits of our IRS AIR Program Reporting include:
-Meeting IRS required deadlines, avoiding costly penalties.
Geo Location Map Reporting: A powerful, ACA compliant tool that efficiently and effectively determines provider network accessibility through the use of geographic data. By using the provider’s exact location, our maps create a precise picture of distance and accessibility.
Benefits of our Geo Location Map Reporting include:
-Our Geo Location Map Reporting is designed to meet all state requirements, regardless of the location of the carrier.
-Precision mapping, as our map reporting creates precise provider mapping and distance calculations.