Claims Management

Claims Management

Healthcare companies are faced with tremendous pressure from government entities, partners, and their customers. Claim overpayments, adjudication errors, less reimbursements, and operation costs significantly decrease profitability. Companies are faced with the burden of purchasing over-priced software that is costly and invasive to implement.

Our Approach

Our philosophy is simple, provide a powerful and flexible solution to work with administrative data.

Claim related documents can be easily accessed, modified, and correlated with our EDI software. Our goal is to simplify the administration of claims processing. T-Connect provides a framework to break down, analyze, apply rules, and track your administrative data. The end result is providing a powerful solution for transparency and data ownership.

Capabilities

Streamline
Operations
Improve
Accuracy
Provide Ultimate Transparency
Powerful
Processing

Streamline
Operations

Streamline Operations
  • Streamline the configuration of adding new partners by leveraging automation features. Simply select a sample partner document and T-Connect will automatically add the partner and agreement configurations.
  • Simplify setting up claim documents by leveraging repeatable template processes.
  • T-Connect Claims Management supports EDI 837I, 837P, 837D, 277CA, 999, 835 documents.
  • Transform proprietary claim files into X12 837 formats quickly and easy.

Improve
Accuracy

Improve Accuracy
  • Customize or use pre-built workflows to process claim related documents according to your needs. Configure through the T-Connect Management Portal to quickly set up processing according to your needs.
  • Apply industry standard SNIP level edits with out-of-the-box rules or utilize the existing framework to quickly add customized policies.
  • Edit, and resume messages on-the-fly capabilities.

Provide Ultimate Transparency

Provide Transparency
  • View correlated claim reports to quickly show paid, rejected, and acknowledged claims.
  • Gain insight into claims processing status and track bottlenecks quickly with reports and management screens.
  • Access data directly to simplify integration with your systems.
  • Flows are tracked and stored at every step.

Powerful
Processing

Powerful Processing
  • Improve processing timeliness with T-Connect’s state-of-the-art processing engine. Process over 1 million claims in minutes.
  • On-premise hardware or cloud hosted virtual machine is supported.
  • Commodity hardware and servers can be used.
  • T-Connect can be installed on modest single server and scales up or out as processing increases.

Client Story

CFHP-white

Community First Health Plans (CFHP) is a San-Antonio-based, non-profit health plan providing health care coverage for hundreds of thousands of members of the diverse south-central Texas community.

Challenge

CFHP faced numerous operational and compliance challenges related to an aging EDI integration platform. 837, 835, 834, 999, and 277-CA inbound and outbound processes required replacement. CFHP wanted to utilize their long-time, trusted implementation partner for the T-Connect implementation. CFHP had a very aggressive deadline. Roadmap for 2018 includes QNXT Connect integration.

Solution

In January 2018, CFHP purchased the T-Connect platform to replace their legacy integration system. Claims, payments, enrollments, and response file workflows were rapidly implemented to replace legacy processes. CFHP’s implementation partner was impressed with T-Connect’s flexibility and speed-to-market characteristics. Tallan successfully met their deadline and implementation requirements.

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