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Transform Claims Processing with ClaimAction

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Inefficient Claims Processing Giving You a Headache? – Take Action

Increase Data Accuracy, Shorten Processing Cycle Times and Lower Costs with ClaimAction

ClaimAction

Speed and accuracy: processing high volumes of medical claims through intelligent automation helps businesses deliver higher levels of efficiency that does more than reduce costs.

For organizations that rely on manual processes, managing medical claims documents and data is labor-intensive and error-prone, injecting unnecessary risk into the process.

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With ClaimAction medical claims processing software from Artsyl, your organization can improve margins, minimize touch points and eliminate processing bottlenecks.

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Capture medical claims data without the need for custom software coding

Route claims data and documents automatically to the right claim examiner, based on your business rules

Configure complex benefits and reimbursement rules to streamline processing and reduce payment delays

Respond quickly to changing government regulations and support data, document and process compliance


ClaimAction medical claims software is pre-configured to capture every data field from HCFA-1500/CMS-500 medical claim forms as well as UB-04/UB-92 forms used by hospitals and other institutional healthcare providers. As a result, ALL critical data is extracted from paper or digital claim documents.

By leveraging your claim document images, extracted transaction data and your business rules, ClaimAction can automate your entire claims process, all the way to the creation of claim records in your back-end data systems--in a HIPAA-compliant 837 data format.

ClaimAction Features

Accelerate Claims Processing
Intelligent automation with powerful data capture technology dramatically lowers manual data entry, and boosts efficiency while reducing errors by validating data against claim records.

Improve Visibility and Control
ClaimAction puts claim information, including documents, data and workflow status at your fingertips, 24x7.

Empower Your Staff and Boost Service Levels
Empower your staff and take the pain out of the claims process by relying on Artsyl’s intelligent automation for processing medical claims. Eliminate manual data entry and document handling. Automate workflow routing and monitoring, and allow your staff to focus on resolving exceptions and issues that require the highest levels of care and attention.

Maintain Clear Audit Trails
ClaimAction keeps a complete audit trail of every touch point within the claims process, so users can monitor whether or not the proper checks and validations took place.

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Medical Claims Processing
with ClaimAction

ClaimAction Specifications

Multi-Channel Capture

  • Scanned Images – TIFF, PDF, JPEG, BMP, PNG
  • Email – POP3, LotusNotes
  • Fax Servers – RightFax
  • FTP/FTP-S
  • Electronic – XML Tickets

Rules-Based Validation of Data

  • Vendor look-ups
  • Mathematical reconciliations
  • PO matching
  • 3-way matching
  • Early-Pay alerts
  • Customizable rules

Automatic Document Classification

Classification of multiple document types for automatic separation and routing

Automatic Routing and Notification

Split batches and dynamically route invoices based on conditions set in the intelligent automation workflow. Configure email notifications utilizing either POP3 or LotusNotes

Machine Learning Based Extraction

Independent automatic extraction of
  • Structured
  • Semi-Structured
  • Unstructured Data

Exception Handling Queues

Dynamically route batches or invoices to ‘Exception Handling’ staff for quicker resolution of issues

Intelligent Process Automation Delivers Greater Flexibility, Scalability and Returns on Investment

Artsyl’s ClaimAction is an intelligent process automation solution that taps into its embedded machine learning, advanced data capture technology, and AI-enabled workflow automation capabilities implement straight-through processing of medical claims forms. A wholly no code architectural framework means ClaimAction can be quickly configured to meet individual business requirements and intelligent document processing of diverse types of claims forms, without the need for custom coding or extensive professional services. Delivering most of the required functionality out-of-the-box as a pre-configured application, ClaimAction relies on intelligent automation and self-learning capabilities of Artsyl’s base application, docAlpha, upon which it is built, to adapt to document variability and perform intelligent document processing unattended. Any new input or directions received when addressing errors or exceptions are added to the docAlpha knowledgebase, resulting in ongoing process improvement and performance over time. Most clients are able to achieve results in 90 days, with many realizing a return on investment in as little as 180 days. While results may vary depending on the complexity of the process, ClaimAction and other Artsyl ActionSuite solutions are designed from the ground up for flexibility and scalability, so that the software can adapt as business conditions evolve.

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