The FACTS® family of products supports multiple lines of business within a single information system: Health, Indemnity, TPA, PPO, HMO, PHO, IPA, MSO, Group Administration, COBRA, Section 125-Integrated Flexible Benefits, and Workers' Compensation with Integrated Managed Care for 24-hour coverage.

Expert management of all key components of your business

  • Claim and encounter processing
  • Managed care administration
  • Workers' compensation administration
  • Policy/Benefit administration with support for eligibility, billing, collections and commissions

HIPAA Compliance

From the inception of HIPAA, the FACTS® system infrastructure has been based on HIPAA-compliant solutions. FACTS® is fully committed to ensuring a clear and easy path to HIPAA readiness - well ahead of the federally mandated compliance deadlines.

Interactive "Web" and "Voice-Enabled" Benefits Communication

FACTS® fully integrated, interactive Internet and voice-based systems empower healthcare administrators and professionals with 24 x 7 access to claims and benefit information, and real-time transactions such as EDI claim uploads, through the Internet.

Fully integrated, advanced technologies for added functionality and advanced productivity

  • Automatic claim adjudication
  • Electronic Data Interchange (EDI)
  • Electronic claim workflow
  • Claim processing/pre-processing
  • Automatic claim coding
  • Optical imaging / IOCR
  • MICR laser check / EOB encoding
  • Standard/custom report generation
  • Letter generation

Managed Care

  • Clinical editing and auditing
  • Provider network management
  • Provider capitation management
  • Pre-Authorization, UR, UM, and physician referrals
  • Point of Service (POS)
  • Primary Care Physician profiling and credentialing
  • Case management

FACTS Family of Products

Core Administration Products

FACTS® CLAIMS & ENCOUNTERS™ - Claim & Encounter Processing System

Fully automated, real-time processing system for complete, on-line adjudication of medical, dental, vision, prescription drug, disability, and COBRA claims and encounters. Comprehensive, yet highly flexible and easy-to-use system. Sharing of information between subsystems minimizes data entry and human intervention. Provides the necessary components for fast, accurate, and cost-effective processing.

FACTS® ADMIN™ - Policy/Benefit Administration System

Fully automated, real-time benefit administration system, with support for eligibility, billing, collections, and commissions. Addresses all aspects of health coverage remuneration for the administration of all types of health insurance. Support for both group and individual. Also accommodates life and AD&D coverage administration, and offers great flexibility in defining your life products.

FACTS® COMP™ - Workers' Compensation Administration System

Fully automated and comprehensive workers' compensation claims administration system that enables you to administer workers' compensation programs within established managed care guidelines. Adjudication of workers' compensation and health claims within a wholly unified system. Provides an extensive range of proactive cost containment strategies for effective managed care.

FACTS® 125™ - Section 125, Integrated Flexible Benefits Administration System

Fully automated, comprehensive, and integrated system for the management of Section 125, Flexible Benefit plans. Offers complete administration of a full range of flexible benefit programs, from spending accounts to a full cafeteria plan.

FACTS® DCS™ - Consumer Directed Health Plan Administration System

Consumer directed healthcare administration system providing comprehensive financial account management, seamless integration to health claims administration and flex spending account administration, consolidated reporting and explanation of benefits production, and centralized customer service response capabilities. FACTS DCS enables healthcare payer organizations to deliver consumer directed plans to your customers without interruption or increased overhead to your operations.

FACTS® COBRA™ - COBRA Administration System

Fully automated system for the administration of the Consolidated Omnibus Budget Act (COBRA). Complete, on-line administration of a wide range of individual and COBRA eligible health plans including medical, dental, vision, and prescription drugs. From initial COBRA notification through coverage termination, FACTS® COBRA performs the necessary functions to ensure COBRA compliance. Allows for the efficiently and timely flow of pertinent data for your COBRA qualifiers and participants.

FACTS® MICR™ - MICR Laser Check & EOB Encoding System

Laser printing module for print of check with an Explanation of Benefits (EOB). Enables the print of this information along with the required logo, signature, and MICR encoding in only one pass through the FACTS® MICR printer on blank security paper. Simplifies and streamlines all aspects of the check/EOB printing, sorting, and filing process while greatly reducing your administrative and overhead costs.

Managed Care Products

FACTS® PPO™ - Provider Network Management System

Fully automated provider network processing module. Provides you with a fully integrated database for providers (both practitioners and facilities) Contracts are driven by date-of-service, giving you the added capability of unlimited contract periods. Unlimited number of PPOs per plan; unlimited number of providers per PPO; unlimited number of PPOs per provider.

FACTS® CES™ - Clinical Editing & Auditing System

On-line, interactive claim editing and auditing module, which verifies claims for accurate procedure and diagnostic coding, utilizing the Ingenix™ statistical, multi-tiered claims editing database. Allows you to identify excessive and inappropriate care quickly, for effective case management and cost containment. Use of this system offers significant savings.

FACTS® PRE-AUTH & REFERRALS™ - Pre-Authorization, Utilization Review, Utilization Management & Physician Referral System

Fully automated and comprehensive pre-authorization, utilization review , utilization management, and physician referral system. Offers a full range of case management capabilities to track patient activity, as well as containment strategies for effective managed care. Industry database experience combined with the FACTS® PRE-AUTH & REFERRALS system provides an effective tool for establishing goals for treatment and protocols, enabling you to evaluate the strategies which offer you the most cost-effective savings.

FACTS® CAPITATION™ - Provider Capitation Management System

Fully automated provider capitation and sub-capitation module for use by doctors, hospitals, integrated delivery systems, and other types of Managed Care Organizations (MCOs). Supplies providers with the functionality to effectively control and manage all of the major administration needs within a capitated environment. Allows for multi-level capitation setup for multiple lines of business. Supports multiple capitation agreements with providers accommodating variable rates by age, sex, region, and plan.

FACTS® GATEKEEPER™ - Primary Care Physician Profiling & Credentialing System

Fully automated system for the administration of a wide range of Point-Of-Service (POS) plans. Supplies your FACTS® database with a comprehensive database of provider credentials and relationships for effective network and employee election management. Primary Care Physician (PCP) election at the member and dependent level; profiling and credentialing; and backup referral tracking at the plan, network, and provider levels.

FACTS® CASE MANAGEMENT™ - Case Management System

Fully automated case management system. Provides nurse managers and claims professionals with the necessary tools and information for the management and review of hospital and medical services provided through the term of an illness or event. Enables health care professionals to effectively monitor and manage all stages of patient care and treatment in a prospective, concurrent, and retrospective fashion. Highly effective utilization management tool that allows the user to more critically ensure the maintenance of quality health care at the lowest cost.

Front-End Products

OPTIFACTS™ - Optical Imaging / IOCR System

Integrated, front-end system for Intelligent Optical Charater Recognition (IOCR). Allows for on-line document imaging, scanning, storage, and retrieval. Gives you the ability to process a greater volume of claim forms directly into the FACTS® CLAIMS & ENCOUNTERS system quickly, accurately, and consistently. Using OPTIFACTS, you can scan in the original claim form to disk and obtain a printed check instantly.

FACTS® EDI™ - Electronic Data Interchange/Claim Submission System

Electronic claim submission system for the high speed entry of claims and/or member data into the FACTS® CLAIMS & ENCOUNTERS system, directly from a provider or claims clearinghouse. Enables you to transmit hundreds of claims or member records within minutes, virtually eliminating all data entry requirements. Significantly reduces the administrative overhead and costs normally associated with the claims entry process, by incorporating electronic claims processing technology.

FACTS® PRE-PROCESSING™ - Claims Pre-Processing System

Fully automated claims pre-processing system which enables your clerical and non-technical staff to perform claim data entry tasks, easily and efficiently. This pre-processing capability allows you to enter claim information and file it for processing an authorization at a later date, even if you do not have all of the general claim information. Provides your organization with an effective mailroom data entry solution which helps you reduce administrative overhead and costs normally associated with the claims entry process.

Automation Products

FACTS® CODER™ - Automatic Claim Coding System

Automated decision support system which provides for automatic coding of claims based on on-line analysis of claim parameters. Utilizes master coding templates, defined by industry experts through the critical analysis of HCFA and UB92 elements to efficiently determine the appropriate benefit classifications through benefit codes. Minimizes adjuster error in benefit code selection and standardizes claims processing throughout your organization.

AUTOFACTS™ - Automatic Claim Adjudication System

Parameter driven, automatic adjudication module that adjudicates claims quickly, easily, and accurately, with minimal adjuster intervention. Collects claims received via modem, tape, or diskette (using FACTS® EDI), via optical imaging and IOCR (via OPTIFACTS), or via mailroom data entry (using FACTS® PRE-PROCESSING) and creates a batch for automatic adjudication.

FACTS® WDS™ - Electronic Claim Workflow Distribution System

Electronic claim workflow management system for your adjusters. Provides automatic routing of claims entered into the FACTS® CLAIMS & ENCOUNTERS system via FACTS® EDI, OPTIFACTS, or FACTS® PRE-PROCESSING to adjuster work queues on a real-time basis. Ensures your adjusters have the most current and accurate workload possible. Provides your organization with a dynamic environment for enhancing claims throughput and turnaround time.

FACTS® REPORTER™ - Custom Report Generator System

User-friendly, parameter driven and comprehensive ad-hoc report generator. Extremely powerful, yet easy-to-use system for the production, maintenance, scheduling, and running of custom and standard reports. Utilizes the information maintained by the user's FACTS® database. Flexible, custom reporting capabilities provide a wide range of options for specifying the data you want to include in a report, and the formatting parameters for report design.

Interactive Products

FACTS®Web™ - Real-time, Internet Based Claim, Coverage & Benefit Generation System

First e-business platform designed specially for healthcare administrators using the FACTS® system. Facilitates the sharing of real-time information directly from your FACTS® system to insureds, employees, and provider's web browsers through the Internet. Eligibility, plan summary, and claim status information is available in a real-time fashion, 24 hours a day, seven days a week, 365 days a year. Secured and protected access. Leverages the power, connectivity, and efficiency of the Internet into your FACTS® health claims management environment. Includes EDI claims upload capability.

FACTS® IVR™ - Real-time, Telephony Based Claim, Coverage & Benefit Generation System

Interactive voice response system which gives employees, providers, and employee benefit administration representatives access to benefits eligibility and claim status information 24 hours a day, seven days a week, via touch-tone phone. No human intervention required; calls are automatically answered by the system. Gives your customers access to information when they want it, in a timely and consistent manner. Fax back capability also provided.

FACTS Software Solutions

With the FACTS® Custom-Tailored Software Solution you have the option of selecting a complete FACTS® system, fully integrated for optimum efficiency - or you can choose only those modules that meet your specific needs.

System Benefits & Advantages - AT-A-GLANCE

  • Easy-to-learn and easy-to-use systems, with on-line help throughout, that are easily understood by non-technical personnel.
  • Fully on-line, parameter-driven systems that works the way you do - making it easy to process data and generate reports.
  • Flexible, user-defined operation adapts to a wide range of changing conditions.
  • Administrative functions that meet your needs with minimal human interaction.
  • An inherent flexibility that permits the user to establish system parameters while incorporating cutting-edge technology for maximum productivity.
  • Modular/integrated system design allows for multiple processes to run concurrently.
  • Improves efficiency and productivity throughout the organization.
  • Yields improved cash flow.
  • Enhanced control of health care utilization and excessive costs.
  • Extensive reporting capabilities; standard and custom report generation.
  • Fast and easy implementation with minimal disruption to your existing business practice.

FACTS Hardware Solutions

FACTS® & Open Systems - A Winning Combination

The combined technology of FACTS® and open systems architecture offers a solid, technical foundation for the most powerful, open and flexible health claims management system in the industry. You can choose from a number of cost-effective hardware options provided by FACTS® Services, Inc. to match your growing needs - so you will never have to worry about obsolescence or expensive software conversions.

From Windows to Unix, FACTS® can provide your organization with the hardware and software combination that is just right for your current operation and future goals.

Whether you are automating for the first time or need to upgrade your current environment, FACTS® supplies a wide range of high performance open systems. These systems offer unparalleled processing power - under even the most demanding of workloads. Whatever your business size, FACTS® can provide you with the best configuration for your specific needs. After all, the best software deserves the finest of operating environments.

FACTS Services

To ensure your company consistent, quality service, FACTS® "full-service" support program is structured into multiple levels of assistance - from day one of installation throughout system use. Every new FACTS® client is assigned a team of representatives from our development, applications support and technical services staff. This group is available to address any problems or questions you may have regarding system use.

These system specialists ensure that your needs are identified, weighed and serviced in the most efficient and productive manner, from the initial implementation plan, training and data conversions, to ongoing system use. Additionally, FACTS® provides ongoing software maintenance, along with comprehensive user documentation for every system you use. With software maintenance, you also get software releases providing the latest product enhancements, professional and courteous phone support, and 24-hour on-line and modem support. The FACTS® development team is also available to perform customized programming requests to ensure your specific needs are always addressed.

FACTS Software Support

FACTS® Customer Support Center is staffed with employee benefit and health claims management experts and technical personnel to provide problem solving support. FSI offers a variety of support services geared towards meeting your organization's specialized needs.

Unlimited phone support

8:30 a.m. to 5:30 p.m. (Eastern time) Monday through Friday. All calls are taken by knowledgeable specialists who isolate the issue and delegate it to the appropriate in-house personnel for fast action.

24-hour online and modem support

24 hours a day, seven days a week.

Extended Remote Supportsm (ERSsm)

Prompt, full-service user assistance (software/technical) outside the regular work hours (evening/weekends/holidays). To obtain this service, the user contacts FSI in advance to schedule and contract the time they wish to have access to this support. During this coverage time, the user has immediate access to the FSI remote support team for fast and easy problem resolution.

FACTS® Professional Services Groupsm

Consultation and assistance for software and hardware, system implementations, network services, and a variety of specialized services.

FACTS Education & Training

Any system, regardless of how well designed and programmed, will only perform up to the level of its users' capabilities. And the more your staff knows about FACTS®, the better it serves them. For this reason, FACTS® offers one of the most extensive and thorough initial training programs of any system on the market. Training is provided on site and/or in FACTS® home office - depending on individual needs and the complexity of the systems selected.

Educational Programs & Networking Opportunities for FACTS® Users

As additional educational and networking resources for FACTS® users, Ebix Health annually sponsors the INTERFACE training program for hands-on instruction for the upcoming FACTS® release and the FACTS® User Group Conference, which offers an informative mix of presentations and breakout sessions focusing on pertinent industry issues and the role that FACTS® technologies play in addressing them. The conference curriculum for both of these programs focuses strongly on user-requested topics.

FACTS Business Solutions

The Ebix Health - Miami Customer Support Center, in Coral Gables, Florida, is staffed with employee benefit and health claims management experts and technical personnel to provide problem solving support. FSI offers a variety of support services geared towards meeting your organization's specialized needs.

Captiva Software Corporation

Captiva Software Corporation is a leading provider of input management solutions. Since 1989, Captiva's award-winning products have been used to manage business critical information from paper, faxed and scanned forms and documents, Internet forms and XML data streams into the enterprise in a more accurate, timely and cost-effective manner. These products automate the processing of billions of forms and documents annually, converting their contents into information that is usable in database, document, content and other information management systems. Captiva's technology serves thousands of users in insurance, financial services, government, business process outsourcing, direct marketing and other markets. For more information, visit www.captivasoftware.com

Emdeon

(formerly Advanced Business Fulfillment - ABF)
Emdeon, the largest and fastest growing outsourcer for health-care specific document processing and claims communication, provides FACTS® customers with a check and explanation of benefits (EOB) processing system that will help to streamline document processing, printing, and mailing services. Use of Emdeon's services provides customers significant savings in postage, materials, labor, and equipment costs. www.emdeon.com

Ingenix

Ingenix unites the brightest minds to transform organizations into market leaders and improve health care through information and technology. Ingenix serves a diverse customer base within the health care community including health care payers, providers, employers, pharmaceutical companies, workers' compensation and auto liability insurers, and government agencies. For more information about Ingenix and its products and services, visit www.ingenix.com

National Care Network

Since 1994, National Care Network (NCN) has offered medical cost containment services to companies across the country. Through the use of innovative products which are supported by recognized data sets, and by offering pricing transparency, NCN provides its clients with programs that truly reduce overall healthcare costs. For more information regarding NCN, please visit our website at www.ncnelink.com

SourceLynx

SourceLynx, a Preferred FACTS Services Partner, provides cost effective, flexible BPO services to FACTS customers utilizing best-of-breed technology partners. This tightly integrated services model includes Mailroom, Scanning, Data Capture, EDI Clearinghouse, Image Repository, and Adjudication Services. The result is a bundled services offering with seamless integration with FACTS Software. With turnaround times of 24 hours, accuracy of 99.9%, and pre-edits built in to the clearinghouse processing, the result is clean claims and increased auto adjudication rates. www.sourcelynx.com

FACTS Industry Links

The Ebix Health - Miami Customer Support Center, in Coral Gables, Florida, is staffed with employee benefit and health claims management experts and technical personnel to provide problem solving support. FSI offers a variety of support services geared towards meeting your organization's specialized needs.

Self-Insurance Institute of America, Inc. (SIIA)

SIIA is the only national association dedicated exclusively to protecting and promoting the self-insurance risk financing alternative for both group health plans and workers' compensation programs. Founded in 1981, the association has grown significantly, now including members from virtually every state and several countries around the world. SIIA provides membership services in four primary areas: information, education, networking, and legislative/regulatory representation. www.siia.org

Health Insurance Association of America (HIAA)

HIAA is the nation's most prominent trade association representing the private health care system. Its more than 300 members provide health, long-term care, dental, disability, and supplemental coverage to more than 123 million Americans. It is the nation's premier provider of self-study courses on health insurance and managed care. www.hiaa.org

National Managed Health Care Congress (NMHCC)

The NMHCC serves as a knowledge source for the triad of health decision-makers, purchasers, payors, and providers, and seeks to increase the quality and cost effectiveness of healthcare delivery nationally and globally through the identification and communication of new ideas, best practices and innovative clinical and management solutions. Since 1998, it has served tens of thousands of health professionals through quality and timely educational programs, and serves as the conduit to innovative vendors and suppliers developing solutions to the industry. www.nmhcc.org

FACTS Partners

AccuSoft Enterprises

Applications include: Document viewing and processing a wide range of paper documents, from pre-approval to contracts, for health and life insurance claims processing. Applications include: Image-enabling, image processing, and viewing for copiers, scanners, and fax machines. www.asent.com

Alegeus Technologies

Alegeus Technologies is an industry-leading benefit and payment solutions provider that enables their clients – companies engaged in offering benefit services to employers – to differentiate and compete in a rapidly changing marketplace. Alegeus provides a comprehensive suite of solutions and services capable of processing every financial transaction that occurs across the benefit value chain – from enrollment and premiums, to benefit accounts, claims and payments.

Processing more than 11 million CDH benefit accounts and $18 billion in healthcare claims annually, Alegeus has built the industry's most comprehensive, scalable and flexible technology platform. As benefit offerings continue to evolve, Alegeus is able to easily support increasing levels of complexity with regards to the business rules surrounding benefit design, eligibility, payment debits, credits, reconciliation and communications. They process every transaction with unmatched reliability, accuracy and support, as our clients will attest.

As the marketplace dynamics continue to change, clients must consistently re-evaluate and reinvent their service offerings to remain relevant and differentiate themselves. Alegeus is focused on creating solutions that anticipate the coming changes in the benefits world, so their clients are prepared to meet their customers’ needs now and in the future. They have the knowledge to bridge the worlds of financial services, health care, benefits and tax/public policy - allowing them to deliver solutions that enable clients to win in the market, run their business more efficiently, and focus on their core competencies.

Avnet

Headquartered in Tempe, Arizona, Avnet Hall-Mark is an industry-leading, value-added distributor of enterprise servers, storage, software and services, marketing exclusively to the reseller channel. Through operations in the United States, Mexico and Canada, Avnet Hall-Mark provides solutions from industry-leading manufacturers including BMC Software, EMC, HP, IBM, Microsoft, Network Appliance, Oracle, StorageTek and VERITAS - driving growth for partners and manufacturers. www.avnet.com

Dell

Dell is the world's leading computer systems company. We design, build and customize products and services to satisfy a range of customer requirements. www.dell.com

Discovery Benefits

Discovery Benefits is the nation’s largest privately held Third Party Administrator for Flexible Spending Accounts, Health Savings Accounts, Health Reimbursement Arrangements, Transportation Accounts and COBRA. Our philosophy is to provide responsive and flexible administrative services and a solutions oriented approach that provides value for our clients and their employees. Discovery Benefits is a Preferred Partner of Ebix. For more information, contact your Ebix representative or visit www.discoverybenefits.com.

Infinisource

Infinisource was founded in 1986 as COBRA Compliance Systems, Inc., a company specializing, in compliance education and administration of the newly enacted COBRA law. As the market evolved, COBRA Compliance Systems began offering a variety of benefit administration services, acquired a number of other like companies. In 2003 the name changed to Infinisource, Inc. to better reflect its market position. Infinisource grew to 17,000 benefit administration customers.

Today’s Infinisource was created in 2011 by merging with America Onshore, a leading provider of SAAS based solutions in Human Capital Management for employers. In 2012, Infinisource acquired Qqest a growing provider of time and attendance solutions. The acquisition increased the Infinisource customer base to 60,000+ employers.

Hewlett Packard

HP is a leading global provider of products, technologies, solutions and services to consumers and business. The company's offerings span IT infrastructure, personal computing and access devices, global services, and imaging and printing. www.hp.com

IBM

At IBM, we strive to lead in the creation, development and manufacture of the industry's most advanced information technologies, including computer systems, software, networking systems, storage devices and microelectronics. We translate these advanced technologies into value for our customers through our professional solutions and services businesses worldwide. www.ibm.com

Microsoft

Founded in 1975, Microsoft (Nasdaq "MSFT") is the worldwide leader in software, services and solutions that help people and businesses realize their full potential. Visit www.microsoft.com

TigerLogic Corporation

TigerLogic Corporation Data provides a complete software development infrastructure of products and services to enable efficient data management and development of powerful business applications for a globally interconnected world. www.tigerlogic.com

Contact information

Ebix Health - Miami, 18001 Old Cutler Road, Suite 303, Palmetto Bay, FL 33157
Phone: (305) 284-7400
Fax: (305) 284-7440
Email: sales@factsservices.com