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.

Get Support
Contact Sales

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

View all insights

e-Book

10 Things to Ask Your Medical Network Vendor

e-Book

10 Things to Ask Your Medical Network Vendor

See if your EDI Medical Network is ready to meet future healthcare challenges such as the CMS interoperability rule, value-based care, and integrated workflows.

Learn More

e-Book

True View Transparency Mandate Solutions

e-Book

True View Transparency Mandate Solutions

Learn more about how you can meet the CMS transparency mandates to give consumers a True View of cost savings, resulting in higher member satisfaction.

Learn More

Article

The Need for Medical Cost Transparency

Article

The Need for Medical Cost Transparency

Discover how the need for medical cost transparency drives the patient experience.

Learn More

PRODUCT SUPPORT

Need support for
this solution?

Get support
Explore related solutions

Join Community discussions

Find and share knowledge, exchange ideas, and collaborate with peers and Change Healthcare experts to drive your solutions to success.

Let’s start a conversation

We’re here to help you find out how this solution could benefit your organization. Complete the quick form to the right, and someone will reach out to you soon.

Our experts will:

  • Discuss your individual use case and business needs
  • Explain our features, benefits, and services
  • Show how this solution can help achieve your goals

Want more information? Start here.

Thank You

We appreciate your interest in Change Healthcare. A member of our team will contact you to better understand your needs and discuss potential solutions.

Together, we are accelerating the journey toward improved lives and healthier communities.