Claims Pre-Adjudication

An end-to-end Claims intake solution designed for real-time claims image and EDI data tracking from the time they scanned or uploaded; increased effectiveness around HIPAA 5010 step-up/step-down, and ICD-10 edits for organizations aiming at higher member and provider service levels.


Softheon Business Connector Cloud (BC2) Claims Pre-Adjudication gives the healthcare payers all necessary tools to deal with the Claims Pre Adjudication process. Softheon solution integrates easily with a variety of Core Admin systems, including Trizetto FACETS, QMACS, Amisys, QCARE, Diamond, Peradigm, and Xcelys.

Additional benefits of the Softheon Claims Pre-Adjudication solution include:

  • Greater accountability by implementing the ability to audit and track claims cases and related documents
  • Achive higher levels of accuray around HIPAA 5100 and ICD-10 edits
  • Link claims and claim-related information with a subscriber and/or provider to offer a more complete picture
  • Create folders that store claim-related information either by manually scanning or uploading
  • Free up space required to store paper-based claims that come into the business, or even allows for off-site external storage facilities to be a thing of the past
  • Seamless integration with legacy technologies, such as portal applications
  • Allow access to member or provider claim information and claim history
  • Implement and verify business workflow processes by use of Softheon electronic folders, comprised of claim metadata values and related gathered documentation
  • Allow for interdepartmental communication and the transfer of cases in near real time
  • Provide the ability to institute off-shore or remote processing from wherever an internet connection is available
  • Allow for replacement or reference of existing content repositories
Stay up-to-date with the latest Health Reform headlines. Sign up for our Daily Connector Newsletter.
Register Now