Automate medical claims processing
Manage your members' healthcare and networks with a cloud-based healthcare delivery system.
Start-to-Finish Healthcare Delivery System
Includes eligibility, referral and authorization processing, provider contracting, benefit administration, auto claims adjudication, capitation (PCP and Specialty), EOB/EFT check processing, and EDI transfers and reporting.
Flexible Deployment Options
Deploy as a cloud solution or an in-house system. Ideal for managed care organizations (MCOs), independent physician organizations (IPAs), third-party administrators (TPAs), preferred provider organizations (PPOs), and self-insured groups.
Streamline the complexities of administrating eligibility, referral authorization and claims processing. Features and functions maximize data integrity while reducing data entry.
Features of ImagineMedMC™
Claims Pricing Options
Percentage of charges, per diem, DRGs, provider-specific roles, and more
Claims Processing Methodologies
Custom fee schedules with multiple qualifiers, diagnosis-specific processing
Clean claims go from entry to payment with no user intervention. Cost-effective processing
Multiple Selection Criteria for Capitation Processing
Insurance and plan-specific, age, sex, county, risk adjustment factors, and more
No need to wait for global releases. Changes can be done as you need them
HIPAA compliant ASC X12 5010 format including proprietary formats based on your needs
"A lot of companies say that their software can do great things, but that’s not always the case. ImagineMedMC™ can do the things that ImagineSoftware says it can do. Our auto-adjudication rate has really improved. We save a lot of time getting payments out to providers and they’re much more accurate. That’s the most important thing for us.""