Transform Claim Processing with ClaimAction

Inefficient Claims Processing Giving You a Headache? – Take Action

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

ClaimAction

Speed and accuracy: processing high volumes of medical claims through process automation delivers higher levels of efficiency that does more than reduce costs.

For organizations that rely on manual processes, managing medical claim 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 process bottlenecks with this claims processing software.

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Capture medical claims data with no need for custom software coding

Route claim 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 changes in government regulations and support data, document and process compliance


ClaimAction medical claim 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

Accelerated Claims Processing
Intelligent capture technology drastically reduces manual data entry, boosting efficiency while reducing errors by validating data against claim records.

Improved 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 relyng on medical claims software to eliminating eliminate manual data entry and document handling. Automated workflow routing and monitoring allows 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 claim 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

Automated Document Classification

Classification of multiple document types for separation and routing

Automated Routing and Notification

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

Advanced OCR Extraction

Independent automated extraction of
  • Structured
  • Semi-Structured
  • Unstructured data

Exception Handling Queues

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

Robotic Process Automation Delivers Greater Flexibility, Scalablity and Ongoing Return on Investment

Artsyl’s ClaimAction takes advantage of robotic process automation and machine learning technologies in a way that allows partners and customers to quickly configure and implement an automated solution without requiring customized coding or extensive professional services. Delivering most of the required functionality out of the box as a pre-configured application, ClaimAction relies on RPA and self-learning capabilities of the docAlpha transformation platform to adapt as the system identifies errors and exceptions to be handled by a human operator. Any new input or directions received when addressing errors or exceptions are then 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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