Solutions
Claims Adjudication
The user-definable rules and workflow engine within AcceleHealth® make it the most flexible and robust adjudication platform in the industry. This single "content agnostic" architecture empowers business users to construct and deploy their own clinical, adjudication and business process rules to increase auto-adjudication and drop-to-pay rates. With it, Payers are able to support an unlimited number of lines of business with every imaginable combination of clinical, administrative, and benefit rules at very granular levels. Other powerful real-time adjudication features include:
- History Cross-Checking. Performs real-time history cross-checking against a patient's history to optimize benefit administration and medical outcomes.
- Step Therapies. Enables collaboration between Payer, Provider, and Patient in administering treatment programs that can reduce medical costs and improve outcomes.
- Pre- and Post-Adjudication. Why re-price when you can pre-price? Sophisticated clearinghouse-like functionality enhances reimbursement opportunities and reduces administration costs by eliminating re-work.
Finally, AcceleHealth's enterprise class real-time workflow enables Payers to extend auto-adjudication beyond claims processing by automating processes and directing work to the right place at the right time. AcceleHealth can anticipate problems before they occur so more claims pass cleanly through the adjudication engine thus reducing or eliminating costly rework.
