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Claims Platform

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Claims Platform

Drive Claims Results with Technology Solutions

Transform your claims operations – in as little as three to six months — with an industry-leading platform designed to increase efficiency and boost agility.

Claims management and processing is core to your plans’ business and can impact operations from back-office administrative functions to quality initiatives. It is estimated that each year in the United States nearly $300 billion is lost due to claims related waste, fraud and abuse, plan inefficiencies and inaccurate claims. Knowing this, it is easy to see how minor changes in process improvement and accuracy can result in significant gains for a health plan. While many plans look to rework their internal processes, often times they overlook the technology they use to manage and control these operations. Without a powerful platform, plans can struggle with inefficiencies and time-consuming manual processes.

Driving results with an industry-leading claims technology platform

Advantasure delivers a comprehensive, compliant and low-maintenance platform that reduces errors and manual processing. You’ll get the flexibility to select service level and processing needed based on your plan’s operations and objectives, with a high rate of auto-adjudication through automated administration that helps increase payment accuracy.

Platform Capabilities

  • Establish and maintain benefit categories and plans, payment system rules and provider contracts
  • Create and maintain facility/professional data within a defined hierarchy that includes network, facility, group or network, clinic or office and individual physician
  • Administer authorization and referrals against claims, including member and/or providers of the decision (approve, pend, or deny) for each authorization request
  • Accept claims, via EDI or paper, adjudicate them manually or systematically
  • Administer claims reimbursement based on standard or customized reimbursement rules
  • Maintain system codes, including service, diagnostic and internal codes, and benefit categories
  • Generate reports and letters based on processed claims
  • Support delivery excellence in service operations for members and providers

Client Performance

  • Nearly 50% reduction in total operating costs, on average
  • Achieved a 95% auto-adjudication rate

Built for the government healthcare market and changing requirements, our solutions are backed by a team with deep expertise and experience in regulatory, plan, technology, government agency and other fields. Our solutions are designed around delivering the technology platforms and managed services that meet and adapt to changing CMS requirements. We understand the revenue and cost drivers that impact your plan’s goals and day-to-day operations. While our claims platform works as a stand-alone solution it can be combined with our suite of related services, and partners well with our enrollment, billing and other administrative technology platforms, to further amplify your growth.

Extend Functionality: Add-on Solutions

  • Provider Portal
  • Member Portal
  • Correspondence
  • Appeals and Grievances
  • Inter-plan Teleprocessing for Blues plans

Let’s talk about how we can streamline claims functions and drive results for your plan.

Find Out How We Fuel Accelerated Performance

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