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Claims Automation for Healthcare Claims Managers
Enable healthcare claims managers to accelerate claim processing, reduce denials, and improve provider and patient satisfaction.
Challenges
- Complex medical coding and claim validation
- High denial rates requiring rework
- Coordination of benefits across payers
- Prior authorization integration with claims
- Provider dispute resolution
Solutions
- AI-powered coding validation and correction
- Predictive denial prevention with root cause analysis
- Automated COB determination and processing
- Prior auth status integration in claims workflow
- Provider dispute portal with auto-resolution
Key Metrics
30%
Reduction in denial rate
5 days
Faster claim processing
90%
First-pass acceptance rate
$2M
Annual savings from denial reduction
Key Initiatives
- Denial prevention
- Coding accuracy
- COB automation
- Provider relations