A clinically-based claims payment solution for payers that want to create and deploy flexible, automated rules to help improve payment accuracy, reduce appeals, and realize medical and administrative savings.

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Increase Claims Payment Efficiency


Improve claims payment accuracy via automated alignment with CMS-sourced, state regulatory, and medical/payment policies. Increased transparency helps you address changes immediately.


Reduce unnecessary medical costs by staying current with evolving CMS policies and the recognized standards for medically appropriate care.


Streamline your claims adjudication process with clinically-supported claims editing. Apply edits in real time, at any point in your claim workflow.


Enable payment innovation with simplified management of complex, mixed payment rules. Adjudicate claims in the context of your claims history, adjusting for specific provider contracts.


Improve provider payment transparency by sharing claim edit rules, detailed clinical rationale, and source information with your providers.


Reduce system development costs and timelines by deploying your own policy changes across plans and regions, ensuring consistency and allowing for quick benefit recognition.

Streamline and Scale Cost-Efficient Payment Innovation


Advanced claims editing

  • Develop and implement policies within your claim workflow which automatically route claims to the appropriate department for review and approval.
  • Maximize editing capabilities by applying standard industry edits, as well as the clinically sound and sourced rules developed by our experienced clinical team.
  • Improve your claims editing process by using our growing body of comprehensive clinical editing rules, coupled with the extensive rule customization flexibility of ClaimsXten.

Policy management

  • Streamline the creation, deployment, and maintenance of policies and edits with our Policy Management module. You can easily apply custom policies to support the unique needs of a plan design or a regulatory requirement.
  • Reduce the number of claims routed for manual review by maximizing your automatic adjudication capabilities using the system’s intelligent management of complex cases.
  • Extend the functionality of ClaimsXten with our flexible rule framework, which includes a wide variety of policy types and logic to support diverse policy needs.

Clinical foundation

  • Execute chosen payment policies and guidelines using KnowledgePacks™ targeted, interest-specific rule sets that provide the clinical foundation of rules and logic necessary for intelligent edit recommendations.
  • Rely on our team of practicing clinicians and consultants to maintain and translate complex clinical content into codified rules that can be applied to your individual claim lines and/or claims history.
  • Employ the clinically sound rules within our KnowledgePacks to help minimize provider abrasion, reduce appeals, and ease your administrative burden.

Content maintenance

  • Manage the content supporting your rule edits and preserve an audit trail of your changes with Content Manager™.
  • Access both default Change Healthcare content, as well as your own unique content, to manage payment policies.
  • Leverage read-only access to the rule content referenced in ClaimsXten.

Providing Measurable Value

  • ~4%

    increase in claim auto-adjudication rates

  • 30%

    reduction in appeals

  • 3-8%

    savings rate of total paid dollars

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