Professional Solutions

Since 2000, HCIM has delivered unparalleled professional consulting services to the healthcare payer and managed care industry. Over the years, we have garnered the respect of this tightknit community by fostering enduring long term relationships with our customers and affiliated business partners. Our success has been based upon our extensive and experienced network of talented healthcare professionals, providing our clients with consulting solutions through the application of industry best practices and hands-on claims payer operations and technology experience.

HCIM places management level professionals, operational staff, subject matter experts, program managers, project managers, and training staff at healthcare payer and managed care organizations. We offer an array of services, including:

End-to-End Healthcare Claims Operations Support

  • Benefit plan administration
  • Claims audit and recovery solutions
  • Claims processing and adjustments
  • Eligibility and enrollment administration
  • Pended claims analysis
  • Provider contracting
  • Utilization and Population Health Management

Comprehensive Operational Assessments

  • Business processes re-architecture
  • Management solutions for organizational review and Policies & Procedures
  • Workflow analysis and documentation

Healthcare Payer Core Claims Transaction System Services

  • Configuration, implementation, upgrade, and conversion
  • Proprietary software for legacy data cleanup and record standardization
  • System assessment and procurement

Development Services

  • Custom test plans
  • Data mart/database development
  • Government program guidance (Medicare, Medicaid, Medi-Cal)
  • Program and project management
  • Report development (Crystal Reports and SQL Server)
  • Technical documentation

Supported Claims Systems, Trusted Partners and Affiliates

Aldera

  • AboveHealth®

Altruista Health

  • Guiding Care™

Citra Health Solutions

  • EZ-CAP®

Cognizant/TriZetto®

  • Facets™
  • QNXT™
  • NetworX Pricer
  • Care Advance Enterprise (CAE)
  • TriZetto® Medicare Solutions (TMS)
    –  Enrollment Administration Module (EAM)
    –  Financial Reconciliation Module (FRM)

DST Health Solutions

  • AMISYS Advance™
  • Exeter™
  • PowerMHC®
  • PowerMHS®
  • PowerSTEPP®

Eldorado

  • HEALTHpac
  • Javelina™

EPIC

  • Tapestry

GE Healthcare

  • Centricity™
  • IDX

Health Solutions Plus

  • MediTrac™
  • PerfectClaim™
  • Caretrac™
  • Uniflow™

HealthEdge®

  • HealthRules Payor
  • HealthRules CareManager
  • HealthRules Answers
  • HealthRules Portals

HealthTrio®

  • connect™
  • xpress

ikaSystems

  • ikaClaims
  • ikaPortals
  • ikaSystems Enterprise

OAO Healthcare Solutions, Inc.

  • MC400

Perot Systems

  • DIAMOND®

Plexis Healthcare Systems, Inc.

  • Plexis Claims Manager™
  • Plexis Quantum Choice™

RAM Technologies, Inc.

  • HEALTHsuite® Mercato

ZeOmega

  • Jiva™