TPA

Healthx multi-channel and ASP solutions enable rapid deployment of self-service web portals for members, providers, employers, brokers, and even your own internal use. Our business model and collaborative approach ensures long term professional partnerships that enrich well into the future with enhanced products, features and services. Working closely with other best of breed healthcare partners and hundreds of Payers, keeps Healthx at the forefront of the industry, constantly providing the latest and most complete solutions in the business.

Healthx TPA clients are excelling in the new consumer directed marketplace because it plays to their strengths. Every employer group has its own unique demographic requiring a more custom approach. Custom plan design with custom service features is in a TPA’s DNA. Consumer directed plans require managing healthcare at the member level and providing individually tailored member services. Large carriers often find this level of customization difficult and expensive to deliver. Consumer directed is made for the TPA industry, giving you a chance to regain market share and build margin.

The nature of healthcare communications is changing. Moving forward, health plans and TPA's will need to remain in closer touch with their members. TPAs will use a variety of methods to communicate with members; text messaging, secure email, and automated phone messaging will be used to broaden the number of ways a member may chose to interact with their healthcare benefit provider. Healthx helps TPAs excell in a new consumer driven marketplace.

Healthx solutions offer streamlined data delivery, secure communications, and pre-integrated solutions for a consumer driven marketplace:


A high degree of web portal configurability

  • Secure interactions between members, employers, brokers and providers
  • Dynamic presentation of benefits information based on user roles
  • Direct access to other sites with a single login
  • Eligibility--web, phone, and fax back solutions
  • Claims--submission and status check
  • HIPAA compliant management of PHI
  • Report distribution
  • Bill presentation
  • Provider authorizations and referrals
  • Targeted messaging and information display
  • Multi channel messaging and information management
  • Total web branding specific for each constituent
  • 24X7 self service capabilities and features for all constituents

Disease Management and Predictive Modeling

  • Advanced Reporting and Predictive Modeling
  • Comprehensive Chronic Disease Management
  • Provider Profiling and Intervention

Pre-integrated Consumer Directed healthcare tools

  • Interactive health & wellness awareness programs
  • Web-based personalized Wellness Programs
  • Hospital, Pharma and Physician comparison tools
  • Treatment & Coverage Advisors
  • Illustrated information on surgeries, conditions and tests
  • Reward programs for members

Paperless enrollment & eligibility management

  • High degree of configurability
  • Improving the eligibility management process

Phone/IVR technology

  • Convenient self-service for providers
  • A simple way to reduce provider inquiries to customer service reps

Multi-purse / purpose benefits card

  • Automated employee spending account management
  • Greater FSA, HSA and HRA participation
  • Increased employer satisfaction

National Pharmacy Alliance

  • PBM and consulting services
  • Lower-priced, completely transparent pricing model
  • Significant savings

Convenient online retail services

  • Discounted prices on over-the-counter items
  • Convenient purchasing of durable medical equipment
  • Free shipping on most orders

Automated Outbound call programs

  • Greater response from members as compared to traditional mail campaigns
  • Effective way of driving behavior, i.e. flu shot and mammogram reminders
  • A simple approach to communication

We continue to explore, develop and identify technologies that streamline the business processes for our clients and empower members with the best tools to make more informed healthcare decisions. Our communication and technology solutions are utilized by hundreds of payers, thousands of Providers and Employer Groups and over 15 million members nationwide. Our solutions create Consumer Directed capabilities superior to larger payers today and in the future. We give our payers the ability to customize healthcare services down to the individual member level creating credible competitive advantages over larger payers.