Claims Auto Adjudication

In the healthcare industry claims processing can be burdensome. The manual process is error prone and requires time, energy, and attention to detail.

Simplify your adjudication with our Keystone Claims Auto Adjudication (KCAA) tool that applies your specific business rules to automate the process. With it, you can adjudicate claims in batch or real-time mode, achieving an automation rate of more than 85% at high speed of more than 50,000 claims an hour!

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Here are some highlights of our product:

?????? A high-throughput batch-processing replacement to RPA solutions.

?????? Extensive library of easily re-configurable adjudication rules.

?????? Ability to easily define new adjudication rules using UI or our AI Genie that discovers the target system schema.

?????? An elaborate model for identifying relationship between claims (duplicate, corrected claim, split claim, re-submission, etc.)

?????? A comprehensive module to match authorizations to claims (for any types of services: one authorization matches one or many claims from one or more providers, one claims needs multiple authorizations etc.)