Streamline the claims configuration and automate the maintenance of your benefit and provider data

Minimize the time and resources spent on fixing claims pends and recoveries with the Payer, TPA, and ASO industry’s first claims configuration solution.

Improve Data Accuracy

Industry Challenge

  • Latency between business teams making changes in data vs. claims configuration teams updating the claims system
  • Misinterpretation and incorrect keying of provider and benefit data

Impact

  • Errors and inconsistencies across systems
  • Increase in claims pends

Our Solution

  • Minimizes benefit and provider data configuration timeframes from 18-45 business days to 3-5 business days
  • Reduces time lags in updating claims systems leading to a reduction in claims pends
  • Minimizes benefit and provider data configuration errors
  • Accelerates speed to market

Reduce Claims Pends

Industry Challenge

  • Manually updating claims data
  • Duplicate data entry across systems

Impact

  • Incorrectly paid claims
  • Benefit/provider/contract data configuration errors
  • Increased claims recoveries

Our Solution

  • Eliminates the need to manually update claims data
  • Prevents incorrect claims payments
  • Misinterpretation and inconsistencies

Reduce Claims Recoveries

Industry Challenge

  • Manually fixing pends
  • Back and forth with claims configuration teams and claims operation teams

Impact

  • Excessive time spent on fixing claims pends
  • Operational inefficiency

Our Solution

  • Streamlines configuration of benefit and provider data into the Core-Admin and other systems
  • Mitigates the need to fix claims pends via costly BPM tools

Improve Star Ratings

Industry Challenge

  • Focus on point solutions to fix claims pends and recoveries
  • Lack of attention on fixing the root cause behind it

Impact

  • Inefficient utilization of resources
  • High cost of operations
  • Member frustration

Our Solution

  • Improves collaboration across stakeholders and accurate configuration of benefit and provider data
  • Helps in delivering better provider and member experience in claims adjudication outcomes
  • Leverages a rich business rule and workflow-driven user interface

Why eClaimsEngine™ ?

Minimize claims pends and recoveries, increase member and provider satisfaction, and improve compliance by simplifying claims management.
Claims Recoveries
100%
Configuration Timelines
90%
Admin Costs
75%

Listen to Our Customers

''After using eClaimsEngine™, we saw a 99% reduction in our claims recoveries that were occurring from misinterpretation and incorrect keying in of data.''
— Group Director, Claims Support
''In today’s competitive environment, efficiency is the key to survival and success. eClaimsEngine™ has forced us to look at our claims operations in a new light and helped us realize significant cost savings.''
— Associate Vice President, Configuration & Claims Operations
''ClaimsEngine™ has helped us reduce claims pends and improved our claims adjudication rate. Our claims system is now more robust, efficient, and accurate.''
— Vice President, Group Claims

Frequently Asked Questions (FAQs)

Here are the answers to the most frequently asked questions about implementing end-to-end claims configuration solution and partnering with Simplify Healthcare.

1. What is the claims management process?

Claims management aims at automating every step of the claims process, from data input to payment. When done right, it can streamline claims management, improve efficiency and accuracy, lower costs, and improve customer experiences. 

2. What are the challenges of using typical tools to fix claim pends and recoveries?

Most health plans invest significant time and resources in fixing the pends and claims recoveries after they have occurred. The typical tools used for this are:   

  • BPM tools that attempt to fix the pends via a business rules engine  
  • Manual fixing of pends – which includes resolution via several internal back and forth with the claims configuration teams and the claims operations team  
  • Claim recovery automation – attempting to automate the “fixing” of claims vs. fixing the error itself 

These tools and methods of fixing claims pends and recoveries are costly, time-consuming, and less effective. 

3. How can automation improve claims management for Payers, TPAs, and ASOs?

Automation can reduce the risk of errors occurring in claims management due to manual processes. It reduces benefit configuration and provider data errors and loading timeframes which reduces cost and improves the efficiency of claims management for Payers, TPAs, and ASOs. 

4. Why use a claims management solution?

Our eClaimsEngine™ enables Payers, TPAs, and ASOs to automate end-to-end claims management processes while decreasing claims recoveries by up to 99% and benefit and provider data configuration timelines by up to 93%. It helps Payers, TPAs, and ASOs improve compliance and reduce costs.