Claims Post-Adjudication

Deliver the pended claims to processors faster and more effectively than manual distribution through pre-defined business rules. Softheon BC2 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, within minutes a different hold code appears that encompases the expertise to efficently work the claims. 

Softheon Business Connector Cloud (BC2) Claims Post-Adjudication provides a healthcare organization with all the tools it necessary when handling pended claims processing. Softheon Business Connector Cloud (BC2) easily integrates with a variety of third-party applications- an advantage that similar systems do not offer.

Additional benefits of the Softheon Claims Post-Adjudication 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 streamline claims processing by 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 providing 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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