Claims Processing & Adjudication

Solution

Claims Processing & Adjudication

A better way to manage health insurance claims
  • Omni-channel claims ingestion
  • Automated high-volume data capture and routing
  • Efficient processing through clean claims enablement
  • Reduced resubmission and follow up

Overview

Upgrade your claims processing by unifying data from all incoming communication channels, performing pre-submission checks to create clean claims, and intelligently routing claims for optimal processing using systems capable of intelligent decisioning.

 

Comprehensive business intelligence reports with customized output files allow full visibility over the claims management process and automation technologies limit the need for manual intervention.

Features
Universal Gateway

Capture claims at the point of service, from any channel (paper, email, fax, mobile apps, digital portals, and EDI), with translation to location-based language. Ensure the most accurate and efficient compliance and payment processing services, using intelligent intake, extraction, and data enhancement tools.

Appeals & Denials Management

Our system applies business rules to produce clean claims, both prior to submission and during pre-adjudication. This helps prevent denials and resubmissions, reduce print, mail, and call volumes, and increase auto-adjudication rates so that we ultimately increase member and provider satisfaction.

Intelligent Decisioning

Relevancy tools automatically route documents and claims for appropriate reconciliation. A comprehensive review process reduces downstream manual processing.

Automated Processing

Strategic use of robotic process automation helps to increase auto-adjudication rates, improve processor claims per hour, and reduce pended claims and number of edits.

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