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Speed Claims Reimbursement and Eliminate Inaccurate Payments

Leverage smart claims data capture and validation against medical code sets, pre-built medical claim form and EDI rules, and your unique business rules for fast identification and return of claims containing true biller errors. Leverage the rigorous, thorough and efficient pre-adjudication process to automatically convert only ‘clean’ claims to EDI and route these claims to your downstream adjudication process, enabling faster, more accurate reimbursement and denial processing.

Realize Efficiencies and Fast Return on Your Investment

Automate the multitude of manual steps in your current workflow—from pre-sorting on intake to digitization and validation of claim data, and from correctly identifying and routing each problem claim to a collaborative resolution process between your examiners and billers, to conversion and routing of only ‘clean claims’ to downstream adjudication processing. The result is an efficient, standard, consistent and repeatable process that simply works, and reduces cycles and cost for each and every claim.

Gain Control and Visibility with End-to-End Analytics

Gain visibility and insight across operations at every stage of your paper-based claims process, from capture and transformation through validation, adjudication, re-pricing and payment. Quickly satisfy all internal and external claim status requests from the point of capture forward; identify and address bottlenecks in near real-time; analyze processing paths of each claim to identify areas of focus for continuous process improvements; and deliver accurate, timely data to key stakeholders. Benefit from automatically created audit trails, enforcement of business controls, and quick escalation of issues.

Engage Customers Through Greater Responsiveness and Transparency

Enrich business relationships through greater responsiveness and transparency, and through the ability to share accurate, current information with billers, subscribers and internal customers. Confidently satisfy all claim status requests from the point of capture forward through integrated analytics. Identify, reject, return and resolve claims with biller-initiated errors in a fraction of the time it takes you today. Adjudicate and pay ‘clean claims’ quickly and accurately, and consistently meet established SLAs expected by billers, insureds and your CFO.

Insulate Yourself From Business and Regulatory Changes Through Automation

Deploy a solution that is purpose-built to optimize the digitization and pre-adjudication of claims, and hand-off ‘clean claims’ to your downstream adjudication process. With the core processing ready to use out-of-the box, your claims automation project will hit the ground running on installation. And because it’s built on the highly adaptable and open TotalAgility platform, you are afforded maximum flexibility and power to customize all solution components; connect to your existing systems to meet all of your requirements today and tomorrow as your business and regulations change. With fewer, less-skilled workers able to handle your current load, you will be insulated from fluctuations in business and personnel.

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