Products

Why ActiveClaim?

Reduce the High Cost of Medical Claims Processing

The level of effort and associated costs to accept and adjudicate medical bills are substantial. Whether these bills are traditional CMS-1500 or UB04 (paper forms or electronic), the claims process requires several complex and costly steps:

1. The processor must determine whether the individual represented on the bill has coverage and whether the bill is part of an existing claim. Many cases require the establishment of a new claim.
2. Next, the processor must determine if they can pay the submitting provider. If the provider is new, many on-boarding steps must be completed before the bill can progress through the process.
3. Once the validity of the claim and provider are established, the processor must extract the actual content of the bill, either automatically or as efficiently as possible by manual means. While machine-based validation can accomplish much, it can never eliminate the need for human quality assurance efforts.
4. With the discovery of invalid bills — whether resulting from incomplete or invalid data, lack of coverage, or any number of other causes — comes another document-handling challenge: reducing the substantial staff hours required to inform submitters of invalid bills and manage their revised submissions.

ActiveClaim from Genus Technologies mitigates these costly manual steps, saving processors time and money. 

For more information, get the white paper "Eliminating Choke Points in Medical Claims Processing."