CLAIMSAutomate Medical Claims Processing for TotalAgility

- Automatic classification of professional and institutional claims
- Support for multi-channel capture and rejection workflows
- 100s of pre-built business rules to enforce the specifications that govern the medical forms and EDI
- A validation operator UI to review, correct and disposition claims, and to capture EOBs/Remittance Advice
- An examiner user interface to review and manage rejections and communicate with providers to resolve problematic claims through a 24x7 web portal
- An exception handling framework for routing claims automatically into exception workflows
- Automatic export of clean claims to an ANSI X12-compliant EDI format (837 v5010) for handoff to the downstream adjudication process
- Integration with Kofax Analytics for monitoring capture analytics and processing paths for identifying bottlenecks and making informed process improvements

- Reduced Manual Paper Handling
- Automated Extraction of Key Medical Data
- Fewer Lost & Duplicate Bills or Supporting Documents
- Increased Visibility of Claims Status
- Workflows that Manage Exceptions
- Stronger Internal Controls
- Integration to Adjudication & LOB Systems
- Decreased HIPAA Risk Due to Unprotected PHI