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To help your organization take claims adjudication to higher levels of productivity and cost-effectiveness, TriZetto® offers QicLink ClaimWorkflow. Integrated with the QicLink processing system, ClaimWorkflow automates manual processes, streamlines workflow and improves business processes. ClaimWorkflow accepts claims/encounter data from multiple sources and in multiple formats and automates routing of claims and encounters, based on rules established by your organization.
ClaimWorkflow offers two methods of adjudication, based on your pre-assigned routing conditions: individual review and approval of claims that don't meet assigned criteria; and automated batch adjudication, following user-defined, plan-specific parameters that also support tracking of progress. When used with QicLink's automatic benefit determination function, ClaimWorkflow assigns payment codes according to your preset definitions. The application also allows you to establish criteria for exception claims-those not eligible for automatic adjudication-and, for audit purposes, to print lists of exception claims and line items that don't pass the automated editing process.
Benefits
- Streamlines claims adjudication
- Improves speed, accuracy and efficiency by reducing your reliance on manual, paper-based processes
- Eliminates bottlenecks, with seamless processes and real-time delivery of work items and tracking of claims and encounters
- Automates business processes through EDI, OCR and workflow integration as well as batch data-entry and adjudication capabilities
- Reduces processing costs and improves productivity by automating tasks, limiting staff and supervisor intervention, and enabling your team to focus on more-complex functions
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Information
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For more detailed information, please call 1-800-569-1222 or click on the link below.
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