Advanced Claim Management
An advanced claiming solution for payers that want to improve claim auto-adjudication rates and identify the most efficient path to process claims for a higher first-pass rate and lower costs.
Improve Claim Auto-Adjudication Rates
Network edits & enhancements
- Delivers claims efficiently. We validate, augment, replace and normalize provider-submitted data within a claim to improve auto-adjudication and reduce time working pended claims.
- Accesses current and comprehensive payer information. Advanced Claim Management rejects or segregates claims using payer-defined criteria, as well as identifies and rejects duplicate claim submissions.
- Applies client-specific pre-adjudication business rules to claims to reduce manual intervention in the adjudication process and improve processing cost-per-claim.
Claim routing service
- Leverages hosted payer data to automatically route claims to/from PPOs for repricing services. Provides a claim to the payer that has already been repriced and is ready for final adjudication.
- Identifies and automatically routes claims to other non-PPO entities besides the original destination for appropriate processing.
- Creates multiple copies of claims to route to a given destination to support tangential claim adjudication processes.
- Render electronic data onto industry-standard paper claim forms. Deliver in an electronic (PDF) format to a customer.
- Support supplemental reporting functionality to be delivered with or without the claim.
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