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Claims Post-Adjudication

Business Connector

Claims
Post-Adjudication

Deliver the pended claims to processors faster and more effectively than manual distribution through the application of pre-defined business rules. Softheon interfaces with the core adjudication system, giving claims processors easy access to everything needed to handle claims. If a different hold code appears after processing, the claim is intelligently routed within minutes to a processor with the expertise to effectively work the claim.

Softheon Business Connector Claims Post-Adjudication gives a healthcare organization all the tools it needs to handle pended claims processing. Softheon Business Connector integrate easily with a variety of third-party applications, an advantage that similar systems do not offer.

Benefits of the Softheon Claims Post-Adjudication workflow solution include:

Industries most advanced "Logarithmic" Business Rules Engine for automated distribution of claims by pend codes: 100,000 claims distributed to 500 work queues under 5 minutes
Enhance and streamlines claims processing, using business rules that effectively identify and differentiate between user-defined pend codes, such as high dollar claims, overpayment claims, etc.
Automated correction of pended claims using adaptive business rules
Enable work to be distributed and performed in a consistent manner, while at the same provides support for the collection of data and statistics to be used for operational and predictive modeling scenarios
Unsurpassed control of claims processor assignment to work queues - Match Talent To Task
Effectively address a myriad of business problems using one platform, with the ability to integrate information across business services if desired
Provide the capability to deny questionable claims before they become pended when the Claims Post-Adjudication workflow solution is integrated with Softheon’s Pre-Adjudication Claims workflow solution
Measure process and staff effectives with real-time event tracking
Ensure meeting service levels, even if the work is performed by a BPO organization

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<h2 style="width: 200px;"><span style="color: #00cccc;">Claims <br />Post-Adjudication</span></h2>
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<h3><span style="color: #00cccc;">Deliver the pended claims to processors faster and more&nbsp;effectively than manual distribution through the application of pre-defined business rules. Softheon interfaces with the core adjudication system, giving claims processors easy access to everything needed to handle claims. If a different hold code appears after processing, the claim is intelligently routed within minutes to a processor with the expertise to effectively work the claim.</span></h3>
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<p>Softheon Business Connector Claims Post-Adjudication gives a healthcare organization all the tools it needs to handle pended claims processing. Softheon Business Connector integrate easily with a variety of third-party applications, an advantage that similar systems do not offer.</p>
Benefits of the Softheon Claims Post-Adjudication workflow solution include:<br />
<ul>
<li>Industries most advanced "Logarithmic" Business Rules Engine for automated distribution of claims by pend codes: <em>100,000 claims distributed to 500 work queues under 5 minutes</em></li>
<li>Enhance and streamlines claims processing, using business rules that effectively identify and differentiate between user-defined pend codes, such as high dollar claims, overpayment claims, etc.</li>
<li>Automated correction of pended claims using adaptive business rules</li>
<li>Enable work to be distributed and performed in a consistent manner, while at the same provides support for the collection of data and statistics to be used for operational and predictive modeling scenarios</li>
<li>Unsurpassed control of claims processor assignment to work queues - <em>Match Talent To Task</em></li>
<li>Effectively address a myriad of business problems using one platform, with the ability to integrate information across business services if desired</li>
<li>Provide the capability to deny questionable claims before they become pended when the Claims Post-Adjudication workflow solution is integrated with Softheon&rsquo;s Pre-Adjudication Claims workflow solution</li>
<li>Measure process and staff effectives with real-time event tracking</li>
<li>Ensure meeting service levels, even if the work is performed by a BPO organization</li>
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