GxClaims™

Medical & Pharmacy Benefits Management Application

Demographic Selection, Clinical Selection, Benefit Plan Certification, Claim Adjudication Analysis, and Integrated Defect Tracking.

100%

End-to-end audit ready traceability

85%

Reduced time to identify and prepare test claims

80%

Increase efficiency identifying root cause for unexpected claim outcomes

Globally Implemented at Fortune 20 Organizations

Product and Managed Services for
  • Defining, testing, and validating claim behavior within an adjudication system for demographic and/or clinical scenarios
  • Augmenting targeted scenarios with randomly selected claims data providing for breadth and depth of testing
  • Comparison and analysis of claim outcomes across source and target benefit plans or adjudication systems
  • Integrated claim analysis with benefit plan configuration
  • Profiling claim outcomes with bulk tagging and tracking capability
  • Intake of benefits
  • Cataloging of benefit plans
  • Versioning of benefit plans
  • Composing benefit plans
  • Reviewing plan components
  • Loading of benefit plans
  • Benefit plan intake & extraction module
  • Benefit plan translations module
  • Benefit plan loading module
  • Benefit plan catalog report
  • Plan components used by a plan report
  • Shared plan components report
  • Impact analysis report
  • Front end technologies such as .aspx or .js
  • Rules engine
  • Rules and benefits database
  • Document parsers and generators
Learn More About GxClaims™