Claims Processing Solution Overview
Upgrade your health insurance claims processing by unifying data from all incoming communication channels, performing pre-submission checks to ensure cleaner claims, and intelligently routing claims for optimal processing using systems capable of intelligent decisioning.
Exela’s PCH Global claims processing automation platform delivers optimized claims submission and processing for both payers and providers and reduces pended claims by more than 30%, claims redetermination requests by 21%, and clinical edit exceptions by 24%.
Our processing infrastructure, certified by HiTrust, streamlines the flow of information by supporting digital submission of claims, health records, payments, and correspondence. We’ll enable you to leverage powerful automation tools to remove inefficiencies and streamline your entire workflow.
Daily Claims and Corresponance Processed
Health and Hospital Clients
A Simple, Unified Digital Gateway
PCH Global enables digital submission of claims, records, payments, and correspondence with multiple providers through a single portal. Direct communication between payers, providers, patients, and data systems reduces friction and automation streamlines the full claims life cycle, from enrollments and claims submission, to processing, adjudication, and payments.
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, these exceptions are also identified for all PCH Claims Manager users.
Fewer Errors, Cleaner Claims
PCH Global reduces claims errors by empowering providers to clean their own claims prior to submission. Our advanced editing platform returns errors back to providers and improves the speed of claims exception processing by presenting erroneous claims in our online portal for providers to resolve, making ingestion, processing, and decisioning easier for payers.
Increased Visibility and Transparency
Any addition, deletion, or modification of transactions, along with user references and timestamps for all entries in the system, are automatically tracked and recorded, providing clear audit trails and ensuring full compliance. Digitized paper claims are kept secure and accessible to authorized users for efficient communication for an optimized workflow.
Automated Appeals & Denials Management
Data capture and appeals routing are handled automatically, boosting efficiency and turnaround time. The system automatically reassociates the original claim with the submitted appeal and classifies appeals and grievances by urgency and resubmission status and keeps you informed of each appeal’s status throughout the process.