Optimized Claims Processing

Simplify administration, lower costs, and increase customer satisfaction

Across the healthcare industry, the processing of claims is the single largest business cost, as well as a key determinant of the customer experience. According to the 2013 NHIRC report, 9.5% of medical claims processed by U.S. health payers are inaccurate. The AMA estimates that $12 billion a year could be saved if unnecessary administrative tasks were replaced with automated systems for processing and paying medical claims.

Wouldn't you like your share of that $12 billion?

Axway can help.

Axway provides a modular integration and data-flow analytics solution that can flexibly connect with multiple external parties and internal systems, while also providing the visibility, alerting, and issue-resolution capabilities that enable optimal claims-processing intelligence and streamlined processes.

How does the solution work?

Using Axway to integrate your internal applications with your healthcare community — on premise or in the cloud — you can automate manual tasks and establish the proper sequence of steps for claims processing. For example, you can reconcile payments from third-party payers to ensure they are properly applied to your billing and AR system, and verify that payer-remittance messages balance with bank deposits. You can also gain complete data-flow visibility with a central repository and visual lifecycle view for individual patient-claim details. And you can ensure compliance with data security requirements around user authentication and access management.

Relevant Products

  • Axway B2Bi

    Integration between your internal applications and your B2B community — on premise or in the cloud

    • Use a rich library of standard EDI and B2B formats to quickly respond to new claims processes (e.g., EDI 835, 837, 277 documents)
    • Easily define, maintain, simulate, print and deploy new maps and integration processes
    • Save money and speed time-to-revenue with consolidated partner onboarding and management
    • Automate and easily update file flows with partners, customers, suppliers and regulatory bodies
    • Enable the flow of revenue-generating data to and from partners with limited IT capabilities
    • Provide mobile and web self-service capabilities, including real-time file tracking and mobile alerts
  • Axway Sentinel

    Visibility and governance for better exception management, self-service and business reporting

    • Provide business and third-party constituents with real-time visual representations of system and claims-process health via intuitive KPI dashboards
    • Use the correlation engine to reduce claims-problem resolution time and costs, improve responsiveness and decrease accounts-receivable cycles
    • Identify trends and opportunities through on-demand or scheduled reporting
    • Easily set exception thresholds and send SMS or email alerts to subscribed personnel
    • Drive SLA compliance by controlling claims data-flow changes as audit events

Supporting Resources

  • Success Story: Public Sector

    ASEAN – Single Window

    How the electronic exchange of border documents puts ASEAN trade into high gear

  • Success Story: Financial Services

    AG2R La Mondiale

    Making pension contributions and payouts pay off

  • Success Story: Financial Services

    Societe Generale Insurance Russia

    Automating and optimizing business processes to reduce the workload for monthly accounting closings by 80%

Ready to optimize how you process claims?

Let’s talk.