A clinically-based claims payment software 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.
Improve claims payment accuracy via automated alignment with CMS-sourced, state regulatory, and medical/payment policies. Increased transparency helps you address changes immediately.
Reduce unnecessary medical costs by staying current with evolving CMS policies and the recognized standards for medically appropriate care.
Streamline your claims adjudication process with clinically-supported claims editing. Apply edits in real time, at any point in your claim workflow. Automatically route claims to the appropriate department for review.
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.
Improve your claims editing process by applying both standard industry edits as well as our growing body of advanced, clinically sound clinical editing rules, coupled with extensive rule customization flexibility.
Reduce system development costs and timelines by deploying your own policy changes across plans and regions, ensuring consistency and allowing for quick benefit recognition.