A rules-based claims payment solution for payers who want help to improve payment accuracy, reduce appeals, and reap both medical and administrative savings.
Support accurate claims payments by automatically verifying alignment with all relevant contract, regulatory, and CMS policies.
Minimize overpayments by adhering to current CMS policies and recognized standards for medically appropriate care.
Drive operational efficiency by automatically routing claims to reviewers who can apply clinically supported edits at any point in your claims process.
Flexibly adapt your claims adjudication to changes in policies and contracts by simplifying management of even the most complex mixed payment rules.
Bring a new level of precision to claims editing by applying a combination of standard industry edits, our growing library of advanced clinically based editing rules, and flexible rule customization.
Helps save time and money by expediting consistent deployment of policy changes across plans and regions.
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