Claims adjudication software for payors, TPAs, and provider organizations.
Provident Solutions builds claims systems for health plans, TPAs, managed care organizations, and provider associations. We cover traditional adjudication at the payor or TPA, plus the large-scale systems that sit between payor and provider.
- Adjudication & Repricing
- Provider Data Management
- EDI Generation & Parsing
- Intake, Authorization & Appeals
- Utilization Management
- Integrated Auditing & QC
Claims processing software for health care organizations.
Provident Solutions offers claims processing software for health plans, TPAs and TPOs, managed care organizations, and provider associations.
We handle traditional adjudication at the payor or TPA, and we specialize in the large-scale systems that sit between the payor and the provider. In both cases, Claims-Flow covers the full range of work: billing, pricing, payment, and AR management. Over more than two decades we've built a set of reusable modules that install as needed to fit your operation.
Modular by design
Choose the Claims-Flow modules you need and build the solution that fits your operation.
Claims Software
Configurable to your claims-processing needs: billing, payment, episodic pricing and repricing, E&M reporting, and AR management. Automation handles the repetitive daily work.
Learn more →EDI Tools
Generation and parsing of complex ANSI files, built in. We support the current X12 specs required by Medicare and other payors: 837, 835, 277, TA1, and 999.
Learn more →Provider Portal
A self-service portal that saves your team time. Providers retrieve EOPs and 835s, check open claims, start an appeal, or upload documentation, all scoped to their NPI.
Learn more →One flow, every module you need
The modules work together to improve productivity, billing and payment accuracy, AR tracking, and utilization management.
Built to the standards health care demands
SOC 2 Type 2
Independently audited and renewed every year
HITRUST Assessed
Most recent certification completed 2023
HIPAA Compliant
Every Claims-Flow module, by design
ANSI EDI Standards
Current Medicare & payor specifications
Want to see Claims-Flow on your data?
Tell us how your operation works and we'll show you which modules fit.