ClaimsXten™

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

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

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

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

claimsxten-enable-payment-innovation

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.

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

claimsxten-reduce-system-development-costs

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

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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.
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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.
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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.
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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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