MEDICAL & PHARMACY BENEFITS MANAGEMENT APPLICATION


GxClaims™ is a demographic and clinical selection, benefit plan certification, claim adjudication analysis and integrated defect tracking process designed to validate claims processing behavior and increase efficiency in identifying root cause for unexpected claims adjudication outcomes.

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end-to-end audit ready traceability

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reduction of time to identify and prepare test claims

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increase in efficiency in identifying root cause for unexpected claim outcomes

Globally Implemented at Fortune 20 Organizations

    distinctive features | invention | asset

    • Spans medical and pharmacy benefits: solves for the combination scenarios and which historical claims will help certify
    • UI driven, does not require coding, scripting of queries
    • Bi-directional traceability of intent all the way to implementation and adjudication performance
    • Pattern match engine for claims adjudication behavior
    • Predictability of pricing performance
    • Predictability of payout performance
    • Complete codebase for RxClaim and variants, and those of other top PBMs
    • Documentation: Process handbook, training material, marketing collateral, engagement and deployment model
    • Pattern library

Demand Generation

New Products Plans for Existing Clients
Products/Plan Updates

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GxClaims™  -   Simplified defect and test processing.