GxClaims

Medical and 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

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Distinctive Features
  • 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
  • Comprehensive QA to support high volume
  • Medical and pharmacy claims testing – synthetic claims generation testing and targeted functional claims based testing
Invention
  • Pattern match engine for claims adjudication behavior
  • Predictability of pricing performance
  • Predictability of payout performance
Asset
  • 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
To unleash the full power of GxClaims®,
use with GxCapture™ (intent capture) and GxCare® (benefits coding).
GxCapture Diagram
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GxCare Diagram
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GxClaims Diagram
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GxClaims™ Brochure 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. READ MORE
GxCare - Medical and Pharmacy Benefits Management GxCare™ Brochure GxCare™ is an automated benefits plan management system for benefit intake, modeling, and cataloging that provides clients simplified benefits access for easier benefits maintenance and complete traceability. READ MORE
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Welcome to the GalaxE A brief introduction to our services and Gx products. Our offerings give the insight you need to recognize, prepare and deploy your data and transform your business for competitive advantage in the future. READ MORE
How End-to-End Management Can Benefit Your Business Managing benefit plans is time-consuming and subject to human error, which can affect performance and regulatory compliance. A firm alignment between business and IT leads to efficient benefits plan management. READ MORE
Work smarter with an integrated benefits management system Managing benefit plans is time-consuming and subject to human error, which can affect performance and regulatory compliance. A firm alignment between business and IT leads to efficient benefits plan management. READ MORE