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Software Functionality Revealed in Detail
We’ve opened the hood on every major category of enterprise software. Learn about thousands of features and functions, and how enterprise software really works.
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Visit the TEC store to compare leading software solutions by funtionality, so that you can make accurate and informed software purchasing decisions.
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 claims administration health insurance


An Approach to HIPAA 5010 conversion
In 1996, Congress passed HIPAA to establish national standards for health care transactions. The main focus is to address patient privacy rights, health

claims administration health insurance  eligibility, claim status, referrals, claims, remittances, member enrollment and maintenance, and premium payments are all impacted by the regulation. This paper discusses HIPAA drivers, compliance schedule, changes, impacts on various stakeholders, benefits of adoption, and approaches to successful completion of this conversion.

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Software Functionality Revealed in Detail

We’ve opened the hood on every major category of enterprise software. Learn about thousands of features and functions, and how enterprise software really works.

Get free sample report
Compare Software Solutions

Visit the TEC store to compare leading software by functionality, so that you can make accurate and informed software purchasing decisions.

Compare Now

Document Management System (DMS)

Document management systems (DMS) assist with the management, creation, workflow, and storage of documents within different departments. A DMS stores documents in a database and associates important information about the documents, to the documents (known as metadata). Most systems provide workflow engines to design and support document creation, publication, and usage. DMS solutions are often used by insurance and health care industries, government bodies, or other organizations processing high volumes of documents. 

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PeopleSoft Building Muscles To Overcome The Rough Patch Part 1


The year 2001, which was an exceptional year of financial performance for PeopleSoft, including record total revenue, record profit, and more than $500 million of generated cash, might have become its liability as well, as it might be quite difficult to repeat.

claims administration health insurance  PeopleSoft Strategic Sourcing, PeopleSoft claims to offer the only solution that manages the entire source-to-settle process for all goods and services, as companies can directly generate contracts and purchase orders from bid evaluation screens, and thereby significantly reduce processing time. In addition, with PeopleSoft Strategic Sourcing, companies should identify and measure suppliers on numerous criteria driving more profitable supplier relationships. PeopleSoft Trading Partner Management (TPM) Read More

What Is the Value Proposition of Support and Maintenance?


Mature systems in any enterprise require an approach different from newer implementations to software support—one that focuses on customization, interoperability, and performance support. Yet despite this fact, most vendors continue to offer the same one-size-fits-all models of support.

claims administration health insurance  issues. For instance, IQMS claims a coveted 98 percent customer retention rate, and has hardly any issues with the value of its S&M programs. It is quite the opposite for many upper tier vendors that attempt to cover even thirty disparate industries while at the same time fiercely competing over the next generation of software platforms. These vendors use maintenance fees to fund new developments. Many customers realize that market battles over application architectures, new middleware, and SOA Read More

PegaWorld 2011 Revisited


How did Pegasystems avert disaster and become one of the fastest growing technology companies? The business process management (BPM) vendor started delivering software that users could change relatively easily. TEC Principal Analyst P.J. Jakovljevic takes a close look at Pega BPM and how this customer-centric software with its unique approach to process execution and modeling has contributed to Pegasystems’ success.

claims administration health insurance  case management (loan origination, claims management, etc.), quoting and order capturing, and predictive decision-making (next best offer to a customer), are expected to do well. Last but not least, Pega Cloud should do well in the future. PJ: What are the particular capabilities (that solve what pain points) that your products still do and no one else does? KA: Off the top of my head, the following distinct Pega BPM traits come to mind: a unified BPM (and CRM if you will) platform across business Read More

An Unusual Human Capital Management Suspect


With Infor Human Capital Management (HCM) 3.0, Infor has combined transactional and strategic human resources functionality with planned integration to its flagship enterprise resource planning and extensions solutions, so that customers can better align HCM initiatives with overall business strategy.

claims administration health insurance  and productivity. The vendor claims that a vast number of existing customers surveyed have told it that they want to 1) improve workforce performance through accountability and visibility; 2) achieve greater efficiency and effectiveness by adding value to processes and increasing capabilities; and 3) lower total cost of ownership (TCO) through application flexibility and compatibility. To accommodate the last requirement—lower TCO through application flexibility and compatibility—the suite is built Read More

Electronic Medical Records: An Introduction


Electronic medical records (EMR) serves a niche market. This software caters specifically to health care professionals working in clinics, private practices, and hospitals. EMR software came about to increase overall patient care and communication between health care staff and departments.

claims administration health insurance  electronic medical records,EMR,EMR systems,paper health records,health care industry,health care organizations,health care system,patient data,medical history,medication list,family history,Institute of Medicine,compliance,voice recognition system,Health Insurance Portability and Accountability Act Read More

SAP Claims Big Gains In The Low-End Battleground


SAP, traditionally regarded as too cumbersome and costly for small or midsize enterprises, has recently been announcing stellar increases in sales and acceptance of its Internet-based mySAP.com by smaller companies. We believe that the incumbent smaller vendors as well as other Tier 1 vendors should prepare for a siege.

claims administration health insurance  Claims Big Gains In The Low-End Battleground SAP Claims Big Gains In The Low-End Battleground P.J. Jakovljevic - December 18, 2000 Event Summary Business applications leader, SAP AG (NYSE ADR: SAP), traditionally regarded too unwieldy and costly for small or midsize enterprises, has been touting stellar increases in sales and acceptance of its Internet-based flagship product mySAP.com by smaller companies. On November 15, SAP America, Inc., a subsidiary of SAP, announced during an analyst briefing that Read More

How Can Insurance Carriers Retain and Reward True Producers?


The enterprise incentive management and sales performance management market is evolving rapidly. Callidus Software remains the vendor of choice for some of the largest companies in the world. The vendor is aiming to cement its leadership within the insurance sector.

claims administration health insurance  issue of mistrust and claims of underpayment (or overpayment) are only compounded in a value chain of independently run entities, especially when there is a lack of visibility. Possibly the best example is the highly regulated insurance space (especially life insurance), whereby insurance carriers have to closely track the credentials (licenses, accreditations, appointments, etc.) of distributors, brokers, or dealers (all commonly referred to as producers), and provide integration to agency management Read More

What Is the Health of My Project?


We all know about the three monkeys: See no evil, hear no evil, speak no evil. But as project managers, we need to control our projects. In order to do this, we must ignore the advice of the three monkeys. We need to see the potential for cost overruns, hear about the risks, and speak about the likelihood of failure.

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Preparing Yourself for the EHR Mandate in Massachusetts


In a climate of economic crisis, federal and state governments are examining ways to evolve the health care system. One way is to adopt an electronic health record (EHR) system. A bill is in effect in the state of Massachusetts to facilitate EHR implementation in all doctors’ offices and hospitals by 2015. To find out how the EHR bill will affect administrative procedures and practices statewide, read this doctor’s guide.

claims administration health insurance  ehr,electronic health record,ehr certification,ehr software,ehr systems,ehr programs,ehr deals,ehr interoperability,ehr adoption,compare ehr,ehr suppliers,ehr information,ehr decisions Read More

AlphaMedica Gets Clean Bill of Health with QuickBooks Enterprise Solutions


The medical marketing agency AlphaMedica, based in New York, New York (US), is a fast-growing business. It needed an accounting system that could keep up with a flurry of activity, generate quick payments and reports, and link smoothly to the in-house systems used to manage the more specialized aspects of its business. For help, it turned to QuickBooks Enterprise Solutions.

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HIPAA Compliance and the eSureIT Online Backup Service


The US Health Insurance Portability and Accountability Act (HIPAA) of 1996 applies to health care providers, health plans, and clearing houses that electronically maintain or transmit health information. Among other things, these entities are required to have data backup plans, disaster recovery plans, and emergency mode operation plans. Fortunately, there is a way to meet these security and contingency requirements.

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Microsoft Health and Microsoft Band Make Their Debuts


Microsoft Corporate Vice President Todd Holmdahl has announced a new platform called Microsoft Health, which includes a cloud service for consumers and the industry to store and combine health and fitness data for better insight. Microsoft Band was also recently launched; it's a smart wearable device that provides a balance of fitness and productivity benefits.

claims administration health insurance  industry watch, wearables, internet of things, iot, Microsoft band, health, fitness, big data, analytics, productivity, mobile, cortana, windows phone, machine learning Read More

Oracle Claims The Worst Is Over And Turns To KISS For A Boost Part 1: The News


Oracle seems to have been trying hard to find a magic formula to ramp up its declining applications revenue. Targeting the lower end of the market with the simplicity hymn might be a part of the solution - provided that the approach is well tuned.

claims administration health insurance  Claims The Worst Is Over And Turns To KISS For A Boost Part 1: The News Oracle Claims The Worst Is Over And Turns To KISS For A Boost Part 1: The News P.J. Jakovljevic - July 10, 2001 Event Summary  In June Oracle Corporation (NASDAQ: ORCL), the largest database provider and one of the largest providers of software applications for e-business, unveiled a new suite of online services aimed at capturing the small business market. It also announced changes to appeal to its larger customers, as well as Read More

Adventist Health System Selects WorkForce Software's EmpCenter Suite


Workforce Software, provider of enterprise workforce management solutions, announced that Adventist Health System has selected its EmpCenter Suite. Adventist Health Systems is a large health care provider with 43 campuses spanning 10 states in the United States. Adventist needed a solution to automate its time and attendance and absence and leave processes a majority of its 55,000+ employees

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