EIS Group, a leading provider of core software systems to insurers, today announced that the latest version of the ClaimCore® claims management solution supports claims for dental insurance and enables 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 extends its award-winning capabilities to help dental insurers to modernize and fully digitize their operations. ClaimCore is a complete dental claim system built on modern and configurable technology to support DHMO and PPO products in both group and individual markets.
ClaimCore for dental claims is deployed at one large, US-based benefits insurer and being evaluated by additional carriers.
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 industry-leading integration capabilities to easily connect with policy and billing systems, provider networks and other data sources.
Using ClaimCore for dental claims provides insurers significant advantages, including:
- 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, providing benefits insurers with additional options for transforming their legacy core systems. When deployed as part of the pre-integrated EIS Suite—comprised of PolicyCore®, BillingCore®, ClaimCore and CustomerCore— eligibility, coverages and customer information are immediately available to claims operations. In addition, the common database and data model in the EIS Suite platform provides a single source of truth with data entered one time and leveraged throughout the entire customer lifecycle.
“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,” said 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.”
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