Automating claims systems and payment processing to help payers grow their business

This purpose‐built, cloud‐based payer solution supports health plans, third-party administrators (TPAs) accountable care organizations (ACOs), independent physician associations, and other large at-risk managed care organizations. Designed to automate and integrate core administration, population health, and medical management under one easy‐to‐use rules-based, data-driven plaƞorm, the Advalent plaƞorm enables health care organizations to minimize the total cost of maintaining traditional Commercial, Medicare, Medicaid and Exchange lines of business while helping them transition to value‐based payment models. And, with implementaƟons that take days rather than months, Advalent not only gets you online and more efficiently sooner, but also has the added benefit of making life a little easier for your IT departments. Our core team, consisting of experts/leaders who have worked in Health Plans, assists health plans in business management consultancy and advisory capacity.

Despite millions invested in complex auto-adjudication systems, payers continue to have to manually interpret and troubleshoot common claim submissions, inaccurate payments, and member complaints.  To pay claims accurately, they need accurate data and interconnected systems which allow for flexibility and growth. Advalent’s adaptable, rules-based core claims administration solution is designed to handle the most complex value-based products with simple, editable rules and real-time adjudication.


Practical, Interoperable Solutions

Claims administration systems are incredibly complex investments that have been built up over years. While 88% of payers report being dissatisfied with their current systems, most feel that the cost, complexity, and risk of replacement outweigh the inconvenience. Advalent understands that payers need practical, incremental solutions that don’t disrupt their business. Our unique approach is to open up our systems for integration with anyone—we don’t see other vendors as competitors but as important collaborators in creating solutions that work for our customers. Our solution supports electronic data interchange services, X12 format 837, 835,27X formats, between healthcare providers and payers for transactions such as claims eligibility, claim status, electronic remittance advice, prior authorizations, and payment communications. Our solution includes provisioning an integrated website (member portal and provider portal) and providing patients with access to information, including eligibility, claim status, claim history, coverage details, payment details, health and wellness information, and provider demographics.

Codified Smart Contracts 

With contracting siloed from payments, payers must invest in complex processes to translate contracts into rules that automated systems can recognize and execute on. Advalent changes the equation by embedding rules directly into your contracting process. Instead of starting with a complex legal document, Advalent customers start by defining the rules that govern payment and then compliant legal documents are automatically generated and kept up to date from within the payment processing system.

Rich Provider Data

Claims administration relies on accurate provider data to appropriately filter, assign, and apply payment rules. By integrating provider directory management services with core administration systems, Advalent eliminates the most significant bottleneck to paying claims correctly and on time.

Take control of your payment process with reliable and transparent systems:
  • Flexible Payment Scheduling

    Pay claims in real-time or schedule daily, weekly, or custom payments.

  • Automated Refunds and Offsets

    Reclaim overpayments on corrections with automated auto-offset recovery. Providers get clear explanations when offsets occur.

  • Provider Payment Transparency

    Via point-in-time adjudication providers know how much reimbursement they’ll receive right away!

  • Lower Provider Call Volumes

    Increased accuracy and transparency drives down call center volume and drives up provider confidence.

  • Higher Compliance

    Speedy processing ensures that your providers are reimbursed as quickly as possible and that you are in compliance with all state and local requirements.

Client Benefits

Simplify your core claims administration with our SMAART technology
  • Increased accuracy
  • Quicker provider reimbursement
  • Automated troubleshooting
  • Simplified adjudication
  • Improved compliance 
  • Reduced call center volume