Claims Processing & Adjudication

Claims Processing & Adjudication

Claims Processing & Adjudication

A better way to manage health insurance claims

Omni-channel claims ingestion

Automated high-volume data capture and routing

Centralized communications

Efficient processing through clean claims enablement

Reduced resubmission and follow up

Medical lockbox and e-payment integration

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.

 

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


Through digitization and automation, PCH Global provides a claims revenue cycle solution that is capable of handling multiple payers, improves first pass accuracy across all payers, provides visibility and tracking of claims status, and provides digital collaboration with payers to accelerate cycle times and reduce DSO.


PCH Global’s claims processing infrastructure, certified by HiTrust, streamlines the flow of information for healthcare providers by supporting digital submission of claims, health records, payments, and correspondence, the platform enables automation, streamlining all aspects of the revenue cycle claims billing, payments, and revenue integrity.

Explore the Benefits

Centralized Digital Gateway

The digital submission of claims, records, payments, and correspondence to multiple payers through a single portal with one login improves the flow of information, removing friction and streamlining all processes. Patient Financial Services personnel can gain significant productivity by using one portal to submit claims to multiple payers.

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.

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.

Edit Validation Prior to Submission

PCH automatically identifies “Certain to Deny” claims, increasing first-pass billing accuracy rates by an average of 24-31%, which directly reduces the volume of denials and manual claims processing and improves DSO. Our edit engines validate all SNIP edits and clinical edits based on general payer guidelines for commercial, Medicare and Medicaid processing.

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 (conversion to 835) services.

 

Increased Visibility and Transparency

The system automatically tracks and records any addition, deletion, or modification of transactions, along with user references and timestamps for all entries in the system, providing clear audit trails and ensuring full compliance. Digitized paper claims become visible to providers to limit processing and communication challenges.

ClaimPRECISE® drives automation and straight-through processing, allowing healthcare payers to accelerate their initiatives to achieve lower transaction costs, improve payment accuracy and move toward real-time transaction processing. Our technology yields superior quality, lower costs and improved compliance. Using technology instead of human labor and offering multiple deployment options, ClaimPRECISE solutions are customized to adapt to client specific business requirements and improves performance without additional capital investment.

Explore Solutions

Unified on a single, cloud-hosted platform, Digital Now is a suite of solutions built to accelerate your digital transformation. With rapidly deployable enterprise software and a team of experienced specialists behind you, you can do business better.

Exela Smart Office is a suite of interconnected workplace technologies and services. Find out how business process automation tools can enhance your employee and visitor experience, optimize space and energy usage, and streamline daily processes.

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