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.
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.
- Increased accuracy
- Quicker provider reimbursement
- Automated troubleshooting
- Simplified adjudication
- Improved compliance
- Reduced call center volume