Medical and Pharmacy Benefits Management Application
GxClaims® is a demographic and clinical selection, benefit plan certification, claim adjudication analysis and integrated defect tracking process designed to validate claims processing behavior and increase efficiency in identifying root cause for unexpected claims adjudication outcomes.
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end-to-end audit ready traceability
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reduction of time to identify and prepare test claims
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increase in efficiency in identifying root cause for unexpected claim outcomes
Globally Implemented at Fortune 20 Organizations
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Distinctive Features
- Spans medical and pharmacy benefits: solves for the combination scenarios and which historical claims will help certify
- UI driven, does not require coding, scripting of queries
- Bi-directional traceability of intent all the way to implementation and adjudication performance
- Comprehensive QA to support high volume
- Medical and pharmacy claims testing – synthetic claims generation testing and targeted functional claims based testing
Invention
- Pattern match engine for claims adjudication behavior
- Predictability of pricing performance
- Predictability of payout performance
Asset
- Complete codebase for RxClaim and variants, and those of other top PBMs
- Documentation: Process handbook, training material, marketing collateral, engagement and deployment model
- Pattern library
To unleash the full power of GxClaims®,
use with GxCapture™ (intent capture) and GxCare® (benefits coding).
use with GxCapture™ (intent capture) and GxCare® (benefits coding).
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GxClaims™ Brochure GxClaims™ is a demographic and clinical selection, benefit plan certification, claim adjudication analysis, and integrated defect tracking process designed to validate claims processing behavior and increase efficiency in identifying root cause for unexpected claims adjudication outcomes. READ MORE
GxCare™ Brochure GxCare™ is an automated benefits plan management system for benefit intake, modeling, and cataloging that provides clients simplified benefits access for easier benefits maintenance and complete traceability. READ MORE Increase Member and Group Retention and Satisfaction Learn how GalaxE provides end-to-end support for the transition of business and technical operations for Payers migrating to READ MORE
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