powering the future of health care together

Partner With Proven Experience: HM Health Solutions

Enterprise Health Solution



The Enterprise Health Solution is a comprehensive and integrated health-plan-operations solution that combines a technical platform, best-in-class processes, and consultation from knowledgeable experts all to make it possible for health-plan partners to effectively run their own businesses.

Within the Enterprise Health Solution is the Claims Product. With this product and its supporting tools, health-plan partners manage their own workflow and apply their business rules to determine if a claim is valid, all while capitalizing on the Claims tool's automation functionality. With our overall average pass-through rate at over 90%, we process several hundred thousand claims a day.

Using a process-driven approach configured to a health-plan partner's business needs, the Claims tool helps the health plan's user tackle the most urgent claims first. The tool also guides the health plan's users through each step of the process online, encouraging a smooth workflow and eliminating the need for paper. The tool is easy to use and follow. We feel confident we haven't missed anything because it guides us step by step.

Information from many areas of the platform can be pulled into just a few screens. Seamless integration eliminates the need for the health plan's users to hunt for answers or pend a claim while waiting for a response. Claim details about benefits, healthcare services, providers, groups, and members are all there, and the work done on the claim is automatically fed back to the other areas of the platform. The information we need is right on our desktops.

The dashboard within the Claims tool gives the health plan's managers an easy way to monitor and reassign their team's workflow, and to assign items by skill or workload so their team can handle claims as efficiently as possible. The dashboard includes real-time reports, too, so managers can spot issues and make adjustments.

I love being able to pull reports and address issues in real time. The Claims tool is also easily tailored with health-plan partners' business rules. We have the system that really fits the way we do business.

The Enterprise Health Solution gives health-plan partners tools to improve their own outcomes and efficiency. Powering the future of healthcare together.

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