Services & Products

Pragmate offers both products and services with the goal of delivering to meet customer expectations.

The power of Pragmate offering is not only in functionality of its products.  It is in its ability to configure the software to match current customer expectations and to provide continuous technical and business support to keep the software with the requirements as they change over time.

 

All our products are built on solid foundation of modern technology and use methodology that supports disciplined and successful implementation.  We keep and maintain full documentation of all functionality so that the customer has full access to the current system description.

Enrollment Processor

Enrollment is essential part of health care payer operation. Even with the X12 834 standard in place, much of the inbound information requires pre-processing and handling of non-standard situations. 

The ENR pre-processing software handles most of the coding problems with a strong rule-based engine and 834 document based architecture.  The ENR pre-processor can use your current membership system to finalize changes.  We have experience integrating with IBM AS400/DB or any SQL accessible database.  

No software or rules can cover 100% of your needs.  The ENR architecture supports easy implementation of changes to handle even the most complex implementations. 

The Pragmate experience, sound architecture of its software, project management skills, and the ability to deliver results quickly may be worthwhile for anyone responsible for enrollment processing. 

Care Management.

 

Continuity of care improves health care results by focusing on care for individual patient and managing it for the optimal effect . 

 

The Medgrail Care Management software is a combination of medical record and plan of care.  The medical record keeps comprehensive records about clinical events, medical screenings, pharmacy, etc. The plan of care can be composed of multiple goals selected on basis of health status.  The plans keep follow-up history and the system can share the plan status with the PCP provider.

Medicare Repricing.

Integration.​

The Medicare pricing formulas are complex and subject to change.  A number of software companies provide web services that make the correct computation.

 

Pragmate PPSAccess software can connect the web service to your claim system in direct manner - no exporting EDI files and importing back is required.  Our facility will use your claim information to request the web service and will update your claims directly. 

Care Quality Metrics.

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