Multi-Channel Intake Member & Provider Info Edits Member Eligibility Validations Medical Necessity Validations Review Case Determination Claim Processing Audit Claims Adjudication Claim Payment Adjustments High Dollar Claims Audits Post-Authorization Case Review
Member & Provider Info Edits
Member Eligibility Validations
Simplify & modernize claims processes.
Making claims decisions doesn't have to be a highly manual process with a high administrative price tag to match. Intelligent business automation empowers you to reduce errors while making adjudication processes hands-free.
Task
Rebuild a unified healthecare system.
CheckHigh Risk Member Identification
Member Outreach Scheduling
Risk Assessment
Personalized Care Plan
Duplicate Case Identification & Merge
Eligibility Management
Questionnaire Management
Member Clinical History Data Gathering
Member Correspondence Letter Generation
Scheduling Appointments
Monitoring Progress
Care Management
As a key healthcare partner, you want to deliver innovative programs that help improve clinical outcomes and ensure at-risk members get treatment on time. With a full view of patient health information, as well as individualized member insights, you can collaborate with providers and engage with members effectively.
Task
Automate Care Manual data entry and processing.
Check