Discover how eClaimsEngine™ works with our Digital Payer Platforms

Benefits1™

eClaimsEngine™ for Benefits1™

Integrates claims system with source of truth for Benefit Plans and Group enrollment information to automate configuration and maintenance in claims system.

Explore Benefits1™ Digital Payer Platform

Provider1™

eClaimsEngine™ for Provider1™

Integrates claims system with the provider master repository to automate configuration and maintenance in claims system.

Explore Provider1™ Digital Payer Platform

Minimize the Time and Resources Spent on Fixing Claims Pends and Recoveries

Leverage eClaimsEngine™ to enable a connected Group, Benefits, and Provider claims journey from one or more data sources to the claims system.

Accelerate Claims Configuration

90% Reduction in Claims Configuration Timelines

Eliminate the need to manually update claims data and minimize Group, Benefits, and Provider claims configuration timeframes from 18–45 to 3–5 business days.

Accelerate Claims Configuration

90% Reduction in Claims Configuration Timelines

Eliminate the need to manually update claims data and minimize Group, Benefits, and Provider claims configuration timeframes from 18–45 to 3–5 business days.

Reduce Claims Pends

Reduce Errors, Misinterpretations, and Inconsistencies

Improve Group, Benefits, and Provider claims accuracy to reduce claims adjudication timelines.

Minimize Claims Recoveries

Ensure Accurate Claims Payments

Prevents incorrect claims payments resulting from incorrect configuration of Benefits and mitigates the need to fix issues via costly BPM tools.

Minimize Claims Recoveries

Ensure Accurate Claims Payments

Prevents incorrect claims payments resulting from incorrect configuration of benefits and mitigates the need to fix issues via costly BPM tools.

Improve Star Ratings

Deliver Member and Provider Delight

Improves collaboration and efficiency through a rich business rule and workflow-driven user interface and helps in delivering better provider and member experience in claims adjudication outcomes.

Listen to Our Customers

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.

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.

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.

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 Group, Benefits, and Provider claims configuration errors and loading timeframes, reducing cost and improving the efficiency of claims management for Payers, TPAs, and ASOs.

Why use a claims management solution?

Our eClaimsEngineenables Payers, TPAs, and ASOs to automate end-to-end claims management processes while decreasing claims recoveries by up to 99% and Group, Benefits, and Provider claims configuration timelines by up to 93%. It helps Payers, TPAs, and ASOs improve compliance and reduce costs.