Our Solutions
Drive Operational Excellence with SCT's Next-Gen
Claims Processing Solution
The healthcare industry is rapidly changing, and health insurance providers are finding that they can save money and improve their return on investment by switching from outdated claims systems to more advanced technological solutions. The limitations of legacy technology—such as inadequate analytics, poor collaboration capabilities, and higher customer expectations—are driving organisations towards embracing technology and automation. This shift aims to elevate productivity and customer service, thereby achieving strategic business objectives.
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Advanced Claims Management Solutions to Accomplish
Your Business Objectives
As a prominent leader in the healthcare sector, our News vendor, CAPS (Core Administrative Processing System), has partnered with healthcare administrators across all major healthcare domains for over two decades to implement enterprise claims management News solutions that deliver results. Our platform offers extensive auto-adjudication to batch readjudication capabilities, empowering you to reach your most ambitious business goals and outcomes. Our Orion claims inventory management solution enables you to efficiently manage claim inventory and work distribution with automation – all within a unified interface.
Key Benefits of the CAPS Platform:
- Auto-Adjudication & Workflow Efficiencies: Our system significantly reduces operational costs and improves the accuracy of claim adjudication, directly impacting your bottom line.
- Enhanced Claims Analysis: Claims analysts can swiftly identify and address claims requiring attention within the same application, streamlining the claims handling process.
- Revolutionary Customer Engagement: Our advanced claims queueing solution and customer relationship management capabilities set new customer interaction and transparency standards.
- State-of-the-Art Technology: With automated EDI solutions and compliance with ICD-10, our platform ensures that your operations are efficient and compliant with current standards.
Transforming Claims Management Through Automation
SCT's CAPS advanced claims queueing solution revolutionizes the way clients manage their claim inventory and work distribution by harnessing the power of automation. This cutting-edge system streamlines the entire claims management process, allowing healthcare payers and organisations to handle a multitude of tasks with increased accuracy and efficiency.
By automating the claims management process, our CAPS' solution reduces the time and effort spent on manual tasks, freeing up claims examiners to focus on more strategic and high-priority activities. The platform's ability to create multiple custom queues and define parameters enables a tailored approach to managing claims, ensuring that the unique needs of each client are met.
Seamless Integration and Intelligent Distribution
Our CAPS' solution offers seamless integration capabilities that facilitate practical task assignment and prioritization, allowing claims analysts to process claims more efficiently. This results in faster processing times, better claim resolution rates, and improved productivity. The intelligent claim distribution ensures that each case is assigned to the most suitable examiner, optimizing outcomes for all involved parties.
Easy Access to Information
Furthermore, easy access to claim summaries and detailed information within the CAPS platform supports informed decision-making and promotes a transparent and efficient claims management process. This accessibility is pivotal to maintaining high standards of service and accountability.
Streamlined claim inventory management is achieved through Plexis' advanced solution, which offers multiple claim queues to support customised workflows. Clients can set claim criteria to define various parameters, such as client or group, benefit plan, claim type, claim details, and adjudication specifics. Orion, the solution's engine, automatically generates a user-friendly summary of the enabled claim criteria, facilitating a seamless experience.
The system allows the creation of analysts who can handle multiple claims or implement anti-cherry-picking functionality, ensuring an efficient distribution of workload. Tasks can be easily assigned to specific users or groups, and both individual analysts or groups of analysts can be assigned to queues. This streamlined process provides a single location for claims analysts to identify claims requiring attention.
Incorporating task functionality within claim queues enables analysts to swiftly identify claims requiring attention and address them within the same application. This streamlined approach significantly boosts efficiency and productivity, as analysts no longer need to navigate through multiple systems or applications to manage their workload.
Having all relevant information readily accessible in a single platform allows analysts to save valuable time that would otherwise be spent searching for claim data across various sources. This time-saving advantage translates into faster claims processing, which ultimately leads to improved customer satisfaction.