Change Healthcare, one of the largest healthcare companies in the U.S., continues to make good on its pledge to invest in interoperability strategies that make it easier for health plans to bridge disparate systems and get claims paid. This week, the company announced that it has completed a major integration project with Pegasystems to help payers ensure fast, accurate payment, reduce costs, and stay compliant with internal and CMS medical policies.
ClaimsXten™ and ClaimsXten™ Select now interoperate with Pegasystems Claims Processing, allowing the companies’ common users to auto-adjudicate most claims in real-time for better, faster payments for providers, payers and ultimately a better experience for consumers.
Health plans can then auto-adjudicate most claims in real time, knowing payment is aligned with their internal medical policies, regulatory medical policies, Medicare, and Medicaid through continuous monitoring and updates by change Healthcare. Claims edits and policy updates once performed manually become highly automated, providing significant administrative cost savings. And from the user perspective, nothing about their daily Pegasystems workflow changes. Users continue to process claims as before, while ClaimsXten quickly and seamlessly processes each claim according to the plan’s specific terms and conditions.
For large health plans, ClaimsXten is an enterprise-class solution that automates payment and medical policy and helps simplify management of increasingly complex clinical and reimbursement rules for value-based reimbursement models, with extensive customization abilities and services. ClaimsXten Select adapts ClaimsXten’s essentials for the unique needs of small to midsize health plans. ClaimsXten Select is available both as SaaS (Software as a Service) or as an on-premise offering.
“We continue to invest in interoperability strategies that make it easier for health plans to connect disparate systems to streamline processes, automate accurate payment, and reduce costs,” said Amy Larsson, Vice President, Clinical Claims Management, Change Healthcare in a statement. “This integration gives Pegasystems’ customers a seamless growth path for taming the complexity of medical and regulatory policy management as well as scaling mixed payment models to improve operational levels. Now they can take advantage of the same claims editing technology and administrative savings realized by seven out of the top ten payers.”