Claims Intake and Automation Solutions for Health Plans

Our solutions improve claims processing speed and accuracy, and power auto-adjudication rates. As a client, you can supplement our automation capabilities with claims queue management services through our global team of healthcare experts who carefully review and adjust information to expedite down-stream claim adjudication results.

Through a mix of automation and claim review services customized for your specific requirements, we help health plans optimize their claims operations.

Healthcare claims capture

Streamline the ingestion, data capture and routing of claims information with our Intelligent Process Automation platform. This powerful technology features:

• Multichannel ingestion – supporting multiple inbound channels, leveraging OCR, machine learning and artificial intelligence (AI) to receive both structure and unstructured claim information.
• Process automation – driven by intuitive user-interfaces that make it easy for both technical and non-technical teams to design and deploy digital workflows.
• Business intelligence – combining real-time dashboards and prescriptive analytics to open up visibility into inbound claims trends and future forecasts.

Claims exception queue processing

While a vast majority of documents can be digitized, those that can’t require manual reviews, which are often challenging and time consuming to resolve. Conduent brings more than 30 years’ experience working with health plans to manage and resolve their claims and enrollment exceptions. Our review efforts are customized to each client’s unique requirements, working within their claims system to review and update records as needed to expedite claim resolution.

Electronic Data Interchange (EDI)

With a HIPAA-driven approach to healthcare EDI and related transaction clearing, we specialize in translating and processing high-volume X12N eligibility and claims transactions in a secured environment. Our industry experts connect with multiple Medicaid, Medicare and commercial payers and offer expertise in payer front-end translation.