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A Better Way to Manage Health Insurance Claims

Optimize your claims submission and editing for fewer denials and faster returns.

Claims Management, Submissions and Editing Solution Overview

Exela’s PCH Global is a powerful and user-friendly digital exchange platform for the healthcare industry that provides a single point of access for claims management, correspondence, and payments.

Through digitization and automation, PCH Global provides a complete claims cycle management solution that can be connected to numerous payers.

Enjoy the benefits of enhanced visibility into the status of your claims, open communication channels for working with payers, and accelerated cycle times for improved cash flow management.

Reduced

Turn around Times

60+

Payer Clients

800k+

Health and Hospital Clients

INCREASED VISIBILITY AND TRANSPARENCY

Increased Visibility and Transparency

PCH Global’s electronic claims submission system automatically tracks and records any addition, deletion, or modification of transactions, along with user references and timestamps for all entries into the system. This provides a clear audit trail and ensures full compliance.

EDIT VALIDATION PRIOR TO SUBMISSION

Edit Validation Prior to Submission

Automatically identify “Certain to Deny” claims to increase first-pass billing accuracy rates by an average of 24-31%.

Exela’s edit engines validate all SNIP edits and clinical edits based on general payer guidelines for commercial, medicare, and medicaid processing.

PCH Global can validate:

  • Clinical Edits
  • Duplicate Edits
  • Prior Authorization Edits
  • Operational Edits (Provider Credentialing)
  • Attachment Edits
  • Administrative Edits
  • FWA Edits
  • Eligibility Verifications
MEDICAL LOCKBOX INTEGRATION

Medical Lockbox Integration

By integrating with Exela’s Medical Lockbox solution, PCH Global centralizes the processing of payments received across multiple channels, including lockbox check payments, ACH payments, and virtual card payments. This provides complete visibility for all payment types, along with associated EOB digitization services (conversion to 835).

CONTINUOUS SYSTEM IMPROVEMENT

Continuous System Improvement

Iterative feedback loop technology allows the system to continuously learn and improve. Predictive analytics identify errors in claims to enable proactive claims management and system flexibility as your contracts change. As payer rules change and are added to our platform, these exceptions are also available for all providers using PCH Claims Manager to submit claims.

STREAMLINED DENIALS MANAGEMENT

Streamlined Denials Management

Denied claims slow down reimbursement, lead to revenue leakage, and require valuable effort that could be better directed toward providing exceptional patient care. Exela offers a robust denials management system to maximize operational efficiencies and optimize reimbursements.

REMOVING COMPLEXITY AND UNIFYING STAKEHOLDERS

Removing Complexity and Unifying Stakeholders

Direct communication with multiple payers and data systems from a single web portal reduces friction and simplifies claims management. Automation streamlines claims submission, claims status checks, and payment tracking.