We provide automated claims benefit adjudication for healthcare payers. The application supports straight-through processing of claims, enabling healthcare payers to significantly increase auto-adjudication rates by offering a wide range of configuration rules such as.
- Flexible benefits
- Authorization validation
- Duplicate claim (line) recongnition
- Filling limit detection
- Payment policies based on individual HCPCS/CPT
- “Call out” rules that retrieve information from neighboring components
New generation Clearinghouse service for the processing of health transactions between Healthcare Providers and Insurance Companies. The transactions are processed in real time (real-time), achieving efficiencies and greater reliability in the data.
We provide value-based care performance management analytic system and business intelligence tools that enable clients to.
- Create custom made dashboards
- Create flexible and customizable reports
- Identify patterns in data to improve internal claim process
- Prevent overpayments
- Optimize risk-based contracts
- Reduce medical loss ratios
- Improve the cost and quality of the healthcare system
Our Data Centers count on all the security, redundancy, and contingency guarantees necessary for continuous processing,
- Eligibility (270-271)
- Claims (X12-837)
- Receipt Notifications (277 and others)
- Claim Status
- Payment Explanation (835)