Advanced Claim Management

An advanced healthcare claims management solution for third-party administrators and 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.

EnhanceClaims Processing

Advanced Claim Management - young woman looking at computer screen

Reduce manual healthcare claims management to save time and money

Significantly improve processing cost-per-claim by reducing manual intervention in the claim re-pricing and/or adjudication process. Reduce the time spent working pended claims with the ability to filter or reject transactions based on customer reference data.

Advanced Claim Management - businesswoman looking at computer screen

Increase claims accuracy to improve efficiency

Improve accuracy by validating, augmenting, replacing, and normalizing provider-submitted data. Identify the most efficient path for healthcare claims to be delivered to the final claim adjudicator.

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Streamline the claims adjudication process to avoid re-work

Use healthcare claims management software to support tangential claim adjudication processes with the ability to provide supplemental data. Appropriately direct pre-adjudicated claims to/from PPO partners for repricing services prior to delivering to a customer for final adjudication.

Advanced Claim Management - coworkers looking at computer screen

Personalize pre-adjudication rules to claims to automate workflows

With our healthcare claims management solution, you apply client-specific pre-adjudication business rules to claims. Advanced Claim Management rejects or segregates claims using payer-defined criteria, as well as identifies and rejects duplicate claim submissions.

What’s Included in Advanced Claim Management

  • Network Edits and Enhancements

    • Deliver claims efficiently
    • Reduce time working pending claims
    • Access comprehensive payer information
    • Reduce manual intervention in the adjudication process
    • Improve processing cost-per-claim
  • Claim Routing Service

    • Automatically route claims to/from PPOs for repricing services
    • Automatically routes claims to non-PPO entities for appropriate processing
    • Routes and processes copies of claims to support tangential claim adjudication processes 
  • Supplemental Services

    • Render electronic data onto industry-standard paper claim forms
    • Easily deliver electronic PDFs to customers
    • Support supplemental reporting with or without claims

Our outcomes

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