Software

Advanced Claim Management

An advanced healthcare claims management 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.

EnhanceClaims Processing

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.

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.

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.

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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