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 Cloud (BC2) Claims Post-Adjudication gives a healthcare organization all the tools it needs to handle pended claims processing. Softheon Business Connector Cloud (BC2) 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