MEDEGY HEALTH SYSTEMS

Providing third party administrative (TPA) services in the healthcare industry, namely, providing services for administrating all or a portion of the insurance claims submission and evaluation process on behalf of health insurers, health insurer sub-contractors, and self-insuring companies; providing insurance administration services, namely, providing third party administrative (TPA) services for administering the relationship between medical service providers and the health insurer's network of medical service providers under specified health insurance plans through credentialing of the medical service provider and configuring of the medical service provider's fees based on the networks the medical service provider is a member of; providing insurance administration services, namely, providing third party administrative (TPA) services for administering the enrollment of existing members of health insurance plans offered by health insurers, health insurer sub-contractors and self-insuring companies through the tracking of associated co-pays, insurance coverage limits, deductibles, referrals to specialists, medical necessity reviews, and required authorizations for specific procedures; providing insurance administration services, namely, providing third party administrative (TPA) services for maintaining compliance by health insurers, health insurer sub-contractors, self-insuring companies, and medical service providers with government regulations governing the healthcare industry, particularly, the regulations required to be followed under the Portability and Accountability Act (HIPAA), the Health Information Technology for Economic and Clinical Health Act (HITECH) and by the Centers for Medicaid and Medicare Services (CMS) and the Agency for Health Care Administration (AHCA); providing insurance administration services, namely, providing third party administrative (TPA) services through a turn-key solution encompassing an infrastructure comprised of the staff, systems, and software-based technology required for cost-effectively managing member benefits and payment of medical service providers by health insurers, health insurer sub-contractors, and self-insuring companies

Providing temporary use of non-downloadable cloud-based software in the healthcare industry, namely, providing cloud-based software for use in facilitating the making of and payment of claims by health insurers, health insurer sub-contractors and self-insuring companies to medical service providers; providing temporary use of non-downloadable cloud-based software for maintaining credentialing information pertaining to medical service providers; providing temporary use of non-downloadable cloud-based software for ensuring compliance by medical service providers, health insurers, health insurance subcontractors, and self-insurance companies with regulations governing the healthcare industry; providing temporary use of non-downloadable cloud-based software for logging and tracking customer service calls; providing temporary use of non-downloadable cloud-based software for managing Electronic Data Interfaces (EDI) using healthcare industry standards; providing temporary use of non-downloadable cloud-based software for enabling telemedicine encounters between patients and medical providers; providing temporary use of non-downloadable cloud-based software for facilitating the processing of and management of government sponsored programs, particularly the program known as the Healthcare Effectiveness Data and Information Set (HEDIS)