Kofax Claims Agility

Optimize health and injury claims operations through best practice medical claims automation


Kofax Claims Agility™ automates processing of paper-based medical claims to improve visibility, control, efficiency and compliance while reducing costs. The solution features multichannel capture of professional and institutional claims, automatic data extraction and validation, a collaborative rejection workflow, automatic conversion to EDI and operational analytics.

Whether you are automating a highly manual process or replacing an existing OCR solution, Claims Agility can help. For highly manual operations, it enables payers and other claims processers to improve workflows by reviewing and correcting errors, and using best practice workflows for exception processing.

Claims Agility contains a comprehensive rule set that validates all data present on medical bills and can rapidly be connected to any data warehouse, claims system or other legacy databases. It includes capture and rejection workflows built on an adaptable, agile platform in which your specific exception or review workflows can easily be implemented. Claims Agility enables your organization to hit the ground running with your claims automation project, greatly reducing the time and cost of implementation and ongoing operations.

Achieve Operational Excellence

Claims Agility streamlines workflow, enforces business controls, provides clear and actionable claims performance information and drives continuous process improvement. Rejected claims are automatically routed to examiners for review and action, who may accept, correct or return claims to providers for correction and collaboration. This enables new levels of engagement with your providers, and reduces cycles and cost while speeding resubmission and reimbursement.

Improve Your Medical Loss Ratio

Cut costs, reduce time and eliminate errors from paper-based claims processes while adding visibility, control and agility for better claims management. By reducing administrative and operational costs, you can improve your Medical Loss Ratio (MLR) and avoid having to issue premium rebates.

Automate Claims Processing

Digitize claims, accurately extract and validate all subscriber, provider, and medical information contained in service lines against medical code sets, NUBC, NUCC and EDI rules, insurer-specific rules, and master subscriber and provider data sources.

Smart Multi-Channel Claims Capture and Validation

Claims Agility efficiently captures all paper-based claims and transforms the information into a digital format for automated processing and verification. Operators may reject claims after reviewing identified errors, or claims may be auto-rejected via rules, speeding the return and correction process. More importantly, only ‘clean claims’ are delivered to downstream processes, reducing adjudication exceptions and ensuring accurate payments.

Improve customer engagement

Energize and enrich customer relationships with world-class responsiveness and transparency and with the ability to readily share information with providers, subscribers and internal customers through faster digitization of paper claims, faster identification, return and resolution of rejected claims and immediate visibility into the claim status from the time the claim is ingested forward. Rapid response to inquiries from your external and internal customers is finally possible, and your responsiveness has never been more critical to your success.

Best Practice Operational Analytics

Claims Agility applies best practice claims workflow to every claim so medical coding review and approval are efficient and conform to policy.  The solution provides visibility of claims processing performance to identify bottlenecks and cost saving opportunities.

End-to-End Analytics

Add Kofax Insight to gain visibility and insight to every stage of your paper-based claims process, from capture and transformation through validation, adjudication, re-pricing and payment. Use historical data to improve future processing.

System of Record Integration

Claims Agility integrates with your systems of record (data warehouses, claims systems, databases and other data stores) to quickly validate subscriber and provider data and accelerate the adjudication process.