This document provides an overview of ESKA's Medical Insurance software system. The system offers comprehensive and flexible functionality for managing all aspects of medical insurance, including setup, production, claims processing, medical networks, reinsurance, and reporting. It applies rules and validations to facilitate efficient transactions while eliminating errors and fraud. The system's intelligent design aims to provide innovative and profitable insurance services that meet clients' needs.
10 Steps to Prepare for ICD-10
These 10 steps will help you get ready
for the transition to the ICD-10 code
sets. You may want to forward this
to those in your organization who are
working on this initiative.
For more information visit http://sites.mckesson.com/practiceconsulting/
BCBS Affiliate strengthens its Healthcare Compliance through Automation and I...MetricStream Inc
A leading healthcare coverage provider chosen MetricStream’s healthcare compliance solutions to automate and streamline critical compliance workflows, while providing a common platform to integrate compliance management across the enterprise.
Sun Knowledge - Practice Management and Revenue Cycle Management Services PPTMichael Smith
Sun Knowledge – A Practice Management and Revenue Cycle Management Company.
Contact Details:
New York Office - 41 Madison Avenue, 25th Floor, NY 10010
Phone - +1 212-400-6100, Email - contact@sunknowledge.com
Website - www.sunknowledge.com
Facebook - https://www.facebook.com/SunKnowledge
Twitter - https://twitter.com/sunknowledge
LinkedIn - https://www.linkedin.com/company/sun-knowledge
Google plus - https://plus.google.com/+SunknowledgeInc
We provide our tailored solutions for any healthcare practices helping them gain more reimbursements with reduced TAT. Over the years, we have developed our specialization with an astute understanding of Payer processes helping you set the tone with better collections.
Our clients prefer us for:
~ Powerful references from major healthcare providers and health insurance payers
~ Instant reduction of billing costs by 70%
~ Managing high volume claims with robust processes
~ Collections of up to 97%
~ 99% medical billing & coding accuracy
Sun Knowledge is a revenue cycle management company and expert in various practice management software. We also provide services for following medical billings, medical coding, account receivable, denial managements, claims adjudications, claim processing, authorization and verification, insurance follow up, and many more.
We are specialize in Hospitals, urgent care centers, DME, orthotics, prosthetics, Nursing home, physician office and many more billing industry.
10 Steps to Prepare for ICD-10
These 10 steps will help you get ready
for the transition to the ICD-10 code
sets. You may want to forward this
to those in your organization who are
working on this initiative.
For more information visit http://sites.mckesson.com/practiceconsulting/
BCBS Affiliate strengthens its Healthcare Compliance through Automation and I...MetricStream Inc
A leading healthcare coverage provider chosen MetricStream’s healthcare compliance solutions to automate and streamline critical compliance workflows, while providing a common platform to integrate compliance management across the enterprise.
Sun Knowledge - Practice Management and Revenue Cycle Management Services PPTMichael Smith
Sun Knowledge – A Practice Management and Revenue Cycle Management Company.
Contact Details:
New York Office - 41 Madison Avenue, 25th Floor, NY 10010
Phone - +1 212-400-6100, Email - contact@sunknowledge.com
Website - www.sunknowledge.com
Facebook - https://www.facebook.com/SunKnowledge
Twitter - https://twitter.com/sunknowledge
LinkedIn - https://www.linkedin.com/company/sun-knowledge
Google plus - https://plus.google.com/+SunknowledgeInc
We provide our tailored solutions for any healthcare practices helping them gain more reimbursements with reduced TAT. Over the years, we have developed our specialization with an astute understanding of Payer processes helping you set the tone with better collections.
Our clients prefer us for:
~ Powerful references from major healthcare providers and health insurance payers
~ Instant reduction of billing costs by 70%
~ Managing high volume claims with robust processes
~ Collections of up to 97%
~ 99% medical billing & coding accuracy
Sun Knowledge is a revenue cycle management company and expert in various practice management software. We also provide services for following medical billings, medical coding, account receivable, denial managements, claims adjudications, claim processing, authorization and verification, insurance follow up, and many more.
We are specialize in Hospitals, urgent care centers, DME, orthotics, prosthetics, Nursing home, physician office and many more billing industry.
Das Bootverhalten von Windows 8 hat bereits für einige Diskussionen gesorgt. Wir schauen die Neuerungen und die Konsequenzen im Detail an und machen uns mit weiteren Security-Neuerungen wie User-Device Affinity für Profiles bekannt. Am Ende dieser Session kennen Sie die Security-Erweiterungen von Windows 8 und können die Vor- und Nachteile für Ihr Unternehmen einschätzen.
hCentive Webinsure Exchange Integration PlatformAlisha North
Are you an insurer worried about integrating to state & federal marketplaces? Are you worried about cost, technology infrastructure, strategy, complexity and deadlines?
This white paper addresses these concerns and more. Learn what steps you need to take and what pitfalls to avoid. Let hCentive be your guide through this challenging and changing landscape.
Solutions to Accelerate Compliance with Affordable Care Act (ACA) Mandates an...Lightwell
The healthcare payer ecosystem in the United States has changed dramatically over the last decade and is expected to evolve at an even faster pace over the next few years. Many world-class companies involved in healthcare payment processing are finding themselves constrained by their existing information technology infrastructure. The silos that they built around Business to Business (B2B) processing are constraining them, making it difficult to achieve governmental mandates and (more importantly) increase processing efficiency and competitive advantage.
The payers’ world today requires adherence to multiple industry standards, government regulations, and industry expectations. It is becoming more technical and payers need to become more agile (Figure 1). The IBM Standards Processing Engine Solution for Healthcare Payers is your answer to B2B enablement in today’s complex HIPAA/ACA (Affordable Care Act) world.
Improve Your SWIFT Infrastructure
For SAA users looking to improve processes for increased transparency, risk management and disaster recovery, EastNets offers the following SWIFT Ready Application solutions:
• en.Reporting®: enables SAA users to benefit from one central view to investigate, monitoring and report all their FIN and XML traffic within one environment;
• en.Recovery®: enables SAA users to restart operations within minutes after an outage instead of hours;
• en.Duplicate Detection®: enables SAA users to save significant time and money by preventing in real time emission of duplicate payments or other FIN messages sent to correspondents; and prevents duplicate instructions received from correspondents from being executed.
• en.PaymentSafe™: enables SAA users a single web-based interface that provides multiple services for SWIFT messaging as well as capabilities for BIC / IBAN validation and calculation, reporting, and watchlist screening and search.
hCentive's WebInsure Consumer is the perfect solution for insurers looking for a proactive approach towards web based insurance solutions. WebInsure Consumer simplifies the implementation of the complex health reforms and offers a cost-effective and highly tailored solution for insurers looking to leverage retail-focussed opportunities arising in the industry.
The value of pre adjudication in healthcare claims processing - banc tec's wh...Jone Smith
BancTec provides Healthcare payers and benefit administrators with pre-adjudication technologies thus replacing error-prone human process and providing application for document management, PPO network management etc.
Das Bootverhalten von Windows 8 hat bereits für einige Diskussionen gesorgt. Wir schauen die Neuerungen und die Konsequenzen im Detail an und machen uns mit weiteren Security-Neuerungen wie User-Device Affinity für Profiles bekannt. Am Ende dieser Session kennen Sie die Security-Erweiterungen von Windows 8 und können die Vor- und Nachteile für Ihr Unternehmen einschätzen.
hCentive Webinsure Exchange Integration PlatformAlisha North
Are you an insurer worried about integrating to state & federal marketplaces? Are you worried about cost, technology infrastructure, strategy, complexity and deadlines?
This white paper addresses these concerns and more. Learn what steps you need to take and what pitfalls to avoid. Let hCentive be your guide through this challenging and changing landscape.
Solutions to Accelerate Compliance with Affordable Care Act (ACA) Mandates an...Lightwell
The healthcare payer ecosystem in the United States has changed dramatically over the last decade and is expected to evolve at an even faster pace over the next few years. Many world-class companies involved in healthcare payment processing are finding themselves constrained by their existing information technology infrastructure. The silos that they built around Business to Business (B2B) processing are constraining them, making it difficult to achieve governmental mandates and (more importantly) increase processing efficiency and competitive advantage.
The payers’ world today requires adherence to multiple industry standards, government regulations, and industry expectations. It is becoming more technical and payers need to become more agile (Figure 1). The IBM Standards Processing Engine Solution for Healthcare Payers is your answer to B2B enablement in today’s complex HIPAA/ACA (Affordable Care Act) world.
Improve Your SWIFT Infrastructure
For SAA users looking to improve processes for increased transparency, risk management and disaster recovery, EastNets offers the following SWIFT Ready Application solutions:
• en.Reporting®: enables SAA users to benefit from one central view to investigate, monitoring and report all their FIN and XML traffic within one environment;
• en.Recovery®: enables SAA users to restart operations within minutes after an outage instead of hours;
• en.Duplicate Detection®: enables SAA users to save significant time and money by preventing in real time emission of duplicate payments or other FIN messages sent to correspondents; and prevents duplicate instructions received from correspondents from being executed.
• en.PaymentSafe™: enables SAA users a single web-based interface that provides multiple services for SWIFT messaging as well as capabilities for BIC / IBAN validation and calculation, reporting, and watchlist screening and search.
hCentive's WebInsure Consumer is the perfect solution for insurers looking for a proactive approach towards web based insurance solutions. WebInsure Consumer simplifies the implementation of the complex health reforms and offers a cost-effective and highly tailored solution for insurers looking to leverage retail-focussed opportunities arising in the industry.
The value of pre adjudication in healthcare claims processing - banc tec's wh...Jone Smith
BancTec provides Healthcare payers and benefit administrators with pre-adjudication technologies thus replacing error-prone human process and providing application for document management, PPO network management etc.
Facing the ever growing complexity of multifinance business there has never been a better help than CONFINS. Developed to meet the needs of financing companies, CONFINS offers a state-of-the-art, web-based core application system that provide a more efficient foundation for business operations by minimizing manual activities, increasing productivity, ensuring data consistency, automating the creation of legal documents, generating comprehensive dashboards & reports, and providing smart queries and secure processing.
SohamLife is a web-browser based integrated Life Insurance Management System that covers the entire business process of Life Insurance right from new business, underwriting, policy servicing, claim processing, accounting, reinsurance to valuation.
Insurance carriers can accelerate manuscript endorsement processing and other policy document dissemination through some easy reengineering and technology process improvements.
A presentation a friend and I worked on while brainstorming ideas for a technology startup. Our objective was to explore opportunities in industries we're familiar with and industries we believe are ripe for disruption. The presentation lays out key industry metrics and profiles successful companies (somewhat startup-focused) within each industry.
The Glonetex Insurance Management Software is specifically designed for SME Companies. The solution currently supports Healthcare, Automobile and Travel Insurance but can be customized for other lines of insurance in a relatively low time frame.
Smarter Contracting to Build Lasting Healthcare Payer-Provider Relationships.docSirion Labs
The success of a health insurance carrier is dependent on its selection of in-network medical professionals. But signing providers into a network is challenging. This blog will help you find out how a smart CLM solution can overcome this challenge.
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My and Rik Marselis slides at 30.5.2024 DASA Connect conference. We discuss about what is testing, then what is agile testing and finally what is Testing in DevOps. Finally we had lovely workshop with the participants trying to find out different ways to think about quality and testing in different parts of the DevOps infinity loop.
Observability Concepts EVERY Developer Should Know -- DeveloperWeek Europe.pdfPaige Cruz
Monitoring and observability aren’t traditionally found in software curriculums and many of us cobble this knowledge together from whatever vendor or ecosystem we were first introduced to and whatever is a part of your current company’s observability stack.
While the dev and ops silo continues to crumble….many organizations still relegate monitoring & observability as the purview of ops, infra and SRE teams. This is a mistake - achieving a highly observable system requires collaboration up and down the stack.
I, a former op, would like to extend an invitation to all application developers to join the observability party will share these foundational concepts to build on:
UiPath Test Automation using UiPath Test Suite series, part 5DianaGray10
Welcome to UiPath Test Automation using UiPath Test Suite series part 5. In this session, we will cover CI/CD with devops.
Topics covered:
CI/CD with in UiPath
End-to-end overview of CI/CD pipeline with Azure devops
Speaker:
Lyndsey Byblow, Test Suite Sales Engineer @ UiPath, Inc.
Unlocking Productivity: Leveraging the Potential of Copilot in Microsoft 365, a presentation by Christoforos Vlachos, Senior Solutions Manager – Modern Workplace, Uni Systems
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Climate Impact of Software Testing at Nordic Testing DaysKari Kakkonen
My slides at Nordic Testing Days 6.6.2024
Climate impact / sustainability of software testing discussed on the talk. ICT and testing must carry their part of global responsibility to help with the climat warming. We can minimize the carbon footprint but we can also have a carbon handprint, a positive impact on the climate. Quality characteristics can be added with sustainability, and then measured continuously. Test environments can be used less, and in smaller scale and on demand. Test techniques can be used in optimizing or minimizing number of tests. Test automation can be used to speed up testing.
A tale of scale & speed: How the US Navy is enabling software delivery from l...sonjaschweigert1
Rapid and secure feature delivery is a goal across every application team and every branch of the DoD. The Navy’s DevSecOps platform, Party Barge, has achieved:
- Reduction in onboarding time from 5 weeks to 1 day
- Improved developer experience and productivity through actionable findings and reduction of false positives
- Maintenance of superior security standards and inherent policy enforcement with Authorization to Operate (ATO)
Development teams can ship efficiently and ensure applications are cyber ready for Navy Authorizing Officials (AOs). In this webinar, Sigma Defense and Anchore will give attendees a look behind the scenes and demo secure pipeline automation and security artifacts that speed up application ATO and time to production.
We will cover:
- How to remove silos in DevSecOps
- How to build efficient development pipeline roles and component templates
- How to deliver security artifacts that matter for ATO’s (SBOMs, vulnerability reports, and policy evidence)
- How to streamline operations with automated policy checks on container images
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Then welcome to this PowSyBl workshop, hosted by Rte, the French Transmission System Operator (TSO)!
During the webinar, you will discover the PowSyBl ecosystem as well as handle and study an electrical network through an interactive Python notebook.
PowSyBl is an open source project hosted by LF Energy, which offers a comprehensive set of features for electrical grid modelling and simulation. Among other advanced features, PowSyBl provides:
- A fully editable and extendable library for grid component modelling;
- Visualization tools to display your network;
- Grid simulation tools, such as power flows, security analyses (with or without remedial actions) and sensitivity analyses;
The framework is mostly written in Java, with a Python binding so that Python developers can access PowSyBl functionalities as well.
What you will learn during the webinar:
- For beginners: discover PowSyBl's functionalities through a quick general presentation and the notebook, without needing any expert coding skills;
- For advanced developers: master the skills to efficiently apply PowSyBl functionalities to your real-world scenarios.
Threats to mobile devices are more prevalent and increasing in scope and complexity. Users of mobile devices desire to take full advantage of the features
available on those devices, but many of the features provide convenience and capability but sacrifice security. This best practices guide outlines steps the users can take to better protect personal devices and information.
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GraphSummit Singapore | The Art of the Possible with Graph - Q2 2024Neo4j
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Join us as we explore breakthrough innovations enabled by interconnected data and AI. Discover firsthand how organizations use relationships in data to uncover contextual insights and solve our most pressing challenges – from optimizing supply chains, detecting fraud, and improving customer experiences to accelerating drug discoveries.
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Presented by Vladimir Iglovikov:
- https://www.linkedin.com/in/iglovikov/
- https://x.com/viglovikov
- https://www.instagram.com/ternaus/
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Created out of a necessity for superior performance in Kaggle competitions, Albumentations has grown to become a widely used tool among data scientists and machine learning practitioners.
This case study covers various aspects, including:
People: The contributors and community that have supported Albumentations.
Metrics: The success indicators such as downloads, daily active users, GitHub stars, and financial contributions.
Challenges: The hurdles in monetizing open-source projects and measuring user engagement.
Development Practices: Best practices for creating, maintaining, and scaling open-source libraries, including code hygiene, CI/CD, and fast iteration.
Community Building: Strategies for making adoption easy, iterating quickly, and fostering a vibrant, engaged community.
Marketing: Both online and offline marketing tactics, focusing on real, impactful interactions and collaborations.
Mental Health: Maintaining balance and not feeling pressured by user demands.
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GitHub: https://github.com/albumentations-team/albumentations
Website: https://albumentations.ai/
LinkedIn: https://www.linkedin.com/company/100504475
Twitter: https://x.com/albumentations
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Paper presented at SYNERGY workshop at AVI 2024, Genoa, Italy. 3rd June 2024
https://alandix.com/academic/papers/synergy2024-epistemic/
As machine learning integrates deeper into human-computer interactions, the concept of epistemic interaction emerges, aiming to refine these interactions to enhance system adaptability. This approach encourages minor, intentional adjustments in user behaviour to enrich the data available for system learning. This paper introduces epistemic interaction within the context of human-system communication, illustrating how deliberate interaction design can improve system understanding and adaptation. Through concrete examples, we demonstrate the potential of epistemic interaction to significantly advance human-computer interaction by leveraging intuitive human communication strategies to inform system design and functionality, offering a novel pathway for enriching user-system engagements.
20240609 QFM020 Irresponsible AI Reading List May 2024
Medical flyer
1. INSURANCE
ESKA® Insures
Medical Insurance
The Medical Insurance system is a forefront for providing
innovative management of medical insurance transactions in a
most efficient and comprehensive manner. It serves as an easy-
to-use tool for the recording and manipulation of production,
medical networks, claims, renewals, and reinsurance operations
for groups and individuals.
As a pioneer in the insurance software industry, ESKADENIA
Software’s insurance knowledge and system compliance with
governmental regulations add more value to the product
comprehensiveness and flexibility.
Main Functionalities
Setup
The Setup module sets the company’s standards for Production,
Claims, and Reinsurance through a comprehensive, yet simple,
parameterised system settings and rules. such as class maximum cover limit, annual limit, case limit,
policy limit, life limit, minimum deductible amount, maximum
The System applies all Medical Insurance business standards deductible amount, and pre-approvals for in-network and out-
such as ICD-10 and ICD-9 along with the price lists of medical network cases.
providers and medicines as regulated by the authorised
syndicates of each country. Comprehensive and flexible premium definition sets the engine
for automatic premium calculation based on the Plan details.
The system supports the following general features:
Several business rules can be set that vary from one insurance
ƒƒSeveral types of carriers; medical insurance companies, TPA company to another such as net risk premiums and gross
funds, TPA Insurance and TPA out. premiums based on benefits, age bands, gender, marital status,
ƒƒHierarchically detailed benefits structure . and family relations.
ƒƒVarious types of capitations such as HMO, dental, and optical.
Production
ƒƒDental setup based on FDI and ADA standards.
The Production module uses the information defined in the system
ƒƒStandardised and non-standardised Service CPTs that comply
Setup and Plans modules to automate production of policies and
with governmental regulations.
eliminate human error in policy issuance.
ƒƒMultiple fees tiers covering complex structures of government
The system supports the complete production cycle covering
and company fees.
quotation preparation, quotation versioning, policy issuance or
ƒƒAdvanced and flexible agent commission structure definition converting quotations to policies, card printing, endorsements,
ƒƒClosed period for production, claims and reinsurance and renewal of quotations and/ or policies.
transactions. The system also allows underwriters to import a group of
members using a pre-defined Excel spreadsheet in any stage of
Plans the underwriting cycle.
Flexible and parameterised insurance products can be defined in The premium amount is automatically calculated based on the
the system as “Plans” to meet customer requirements in different extra net risk premium, discount, and loading percentages which
territory scopes by defining various plans and classes with can be divided into commissions, profits, and administrations.
different benefit covers, ceilings, premiums, exclusions, referrals
For customisation purposes, tailored payment cycles are
and waiting periods for medical insured members.
supported in the system. Moreover, document attachments and
In addition, parameterised validations can be applied on policy, historical notes provide claims auditors with support for decision
case, or member level for effective control and audit on claims making.
2. Quotations ƒƒE-claims entry via the Internet
Based on the medical insurance plans, the system can issue ƒƒMedical pre-approvals can be recorded in the following methods:
and print quotations for prospective and existing customers. Two ƒƒComprehensive approval entry
types of quotations are supported in the system based on age
ƒƒFast approval entry
bands or actual insured members.
ƒƒFax approval
The system automatically calculates the quotation premium
based on the defined plan/ class fees, loadings and discounts. ƒƒOnline and automatic e-approval via the Internet
The system contains a claims auditing engine that applies
Endorsements Types extensive validation rules on medical claims and can either reject
The system enables users to add a number of endorsement types claims or warn the user according to preset rules.
for policies and members including: In addition, the Claims module support different settlement types
ƒƒPolicy extension, cancellation, and reactivation such as complete settlement, partial settlement, down payment,
and adjustment.
ƒƒChanging agents
ƒƒChanging policy plans Reinsurance
ƒƒFreezing and un-freezing policies The system allows users to manage and control multiple
ƒƒMember addition reinsurance treaties and generate bordereaux that distribute
ƒƒMember correction, cancellation, and reactivation shares based on the treaty definition.
ƒƒCharging members for the printing of new membership cards Different types of reinsurance treaties are supported by the system,
such as proportional and excess-of-loss treaties. Moreover, the
system supports automatic reinsurance distribution for policies,
Medical Networks renewals, endorsements, and claims transactions.
The Medical Insurance system enables users to define multiple Claims Knowledge Base
medical networks whereby each network contains providers from
different types, specialties, and prices. In addition, follow up The Medical Insurance system is an intelligent system that has the
periods and multi-discount ranges such as volume discount can ability to build a self-learning virtual utility based on the previous
be applied for each provider. occurrences of ICD and CPT combinations.
Users can define or import price lists of all providers at once or
of each provider separately based on the medical services and Reports
specialities. The system provides numerous reports for production, claims,
reinsurance, and statistical data. Supported reports include:
Claims ƒƒStandard production reports covering schedules, endorsements,
The Claims module resides on a powerful auditing engine that members, and card printing vouchers .
is rich with rules and validations defined in the system Setup and ƒƒStandard claims reports covering approvals, batch covers, claims
Plan/ Class modules on policy and member levels. Therefore, details, and rejected claims.
the system eliminates fraud and human error while facilitating
ƒƒReinsurance reports covering bordereaux and loss advice.
claims entry and audit.
ƒƒStatistical reports covering loss ratio, reconsolidation, utilisation,
The claims processors can enter network and none-network and earned and unearned premium.
claims with filtration for provider speciality and plan/ class covers
taking into consideration policy and member exclusions. Claims
auditors are supported with automatic claims auditing features Queries
based on predefined validation rules for automatic calculation The Queries module allows easy search for policy members,
of the approved claim and fees amounts. premiums, approvals, benefits, providers, transactions, claims
The following claims entry methods are supported: and settlements.
ƒƒComprehensive claim entry Furthermore, the module allows users to generate real-time 2D
and 3D diagrams in a professional graphically-attractive layout.
ƒƒFast claim entry
ƒƒNone-network claims or automatic importing of claims from a pre-
ESK/WA/FL-10:011 Uen-Rev A
defined Excel sheet
Where time and accuracy are fundamental you
want to be sure that all Medical Insurance services
are profitable, yet cover your clients’ needs!
ESKADENIA Software, P.O.Box: 1555 Amman 11821 Jordan, Tel: +962 6 5510717, Fax: +962 6 5510719, E-mail: contacts@eskadenia.com