Claims Processing Automation

Healthcare
Case Study

Claims Processing Automation

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CHALLENGE:

A top 10 healthcare payer organization was continually expanding its reach and market share and partnered with Exela to reduce administrative costs, improve control and accountability, improve EDI submission rates, and enhance customer experience.

SOLUTION:

Exela met this challenge by leveraging the self-service, rule-based PCH web portal and increasing provider engagement. The intelligent document identification system enables provider offices to direct billers to submit claims appeals through the PCH web interface. Automated rule-based workflows drive document submissions to the relevant payer processing department for quick and accurate processing. E-presentment of post-processing notifications eliminates reprocessing delays for providers.

BENEFITS:
  • 35% reduction in payer processing costs

  • 50%+ reduction in cycle times

  • 20% reduction in resubmission rates

  • Increased transparency for payer, providers, and members

  • Reduced member outreach volumes

  • Fewer errors in payments

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