1. Health Plan Solutions Stephanie Rose ECMp, PAHM Insurance Industry Account Manager

2. Claims EDI or paper claims OCR Present claim image from EDI data Automate reject notification without touching a claim Claims workflow automation; augment claims system workflow or take pend code data to manage workflow Prioritize (high dollar, by provider, by $, etc.) Utilize data-centric WorkView applications to manage special processes (fraud, triage multiple claims from one provider for research, etc.)

3. Customer Service Integrate with IVR to automatically present correct information to a CSR during a call Call tracking & recording Instant form creation and workflow routing for member or provider requests that require other internal involvement and/or call backs (case management referral, request for new ID card, etc.) Automated letter generation One-click access to all related content while in other systems

4. Credentialing Credentialing virtual folder & task checklist with timers Integration with NCQH and instant importing of primary and secondary source verification documentation Site visit assessment form via iPad Paper-less credentialing committee meetings & external access to credentialing file Electronic approvals Automated letter creation & easy template modification Revision history & version control for contracts

5. Appeals Online electronic appeal forms Compliance controls with process timers & notifications Incomplete submission alerts & customizable provider notifications & requests for more information Secure external access to appeal file for 3 rd party review Automated letter creation Legal hold and record freeze controls Robust reporting Real-time process analytics dashboard with the ability to launch directly into the workflow process to modify processes, re- distribute work, etc. Online provider tools: status notifications, submit documents, decision summary, etc.

6. Care Management Document centralization, call tracking, task reminders, letter creation, timers, and collaboration workspaces in one view Integration with Claims system

7. Online Forms Management Control revision of forms quickly and easily for verbiage changes (legal, OCI, CMS, etc.) Historical record of revisions for audit compliance Online completion triggers workflow process – enabling SLA compliance in turnaround times. Automated email notification of receipt of form iPad forms (provider site visits, etc.)

8. EHR & Records Management Centralized content management for all content types (electronic documents, paper, fax, email, voice, etc.) Security & access controls enable PHI compliance Historical audit log Integrations with providers for medical records submission (HL7, etc.) Automated records management (static & dynamic business rules) Automated workflow for records subpoenas, litigation holds, etc.

9. Enterprise-Wide Case View Provider: history of claims, appeals, calls, credentialing status, ytd claims $, members in case management, # denied claims, etc. in one view Member: history of claims, grievances, calls, plan type, prior auth history, etc. in one view

10. Prior Authorizations Online form submission History of prior authorizations & automated duplicate detection Documentation completeness alert with automated request for documentation (via email, fax, letter, automated calls, etc.) Integration with Care Management standalone software to augment authorization data with document management, letter creation, workflow automation, reporting and more.

11. Subrogation & SIU Take claims data flagged and trigger automated letters, faxes and emails Automated case file set-up with task reminders, call tracking & contact management Settlement negotiation tracking & collections processing Status dashboards (case aging, collections by day/week/month, by user, unpaid settlement $, etc.) Historical reporting