Software
Advanced Claim Management
An advanced healthcare claims management solution for third-party administrators and 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-claimÌýby reducing manual intervention in the claim re-pricing and/or adjudication process. Reduce the time spent working pended claimsÌýwith 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 pathÌýfor 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 adjudicationÌýprocesses with the ability to provide supplemental data. Appropriately direct pre-adjudicated claimsÌýto/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
Our outcomes
PRODUCT SUPPORT
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