Transforming Claims Processing

Exela’s PCH Global claims processing platform delivers optimized claims submission and processing for both payers and providers.

The platform can deliver a reduction in pended claims of more than 30%, more than a 21% reduction in claims redetermination requests, and 24% fewer clinical edit exceptions.

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Transforming Claims Processing

Exela’s PCH Global claims processing platform delivers optimized claims submission and processing for both payers and providers.

The platform can deliver a reduction in pended claims of more than 30%, more than a 21% reduction in claims redetermination requests, and 24% fewer clinical edit exceptions.

Get in touch

Exela PCH Global Claims Platform Enables Value-Based Outcomes

5/5
Top US
Healthcare
Payers

9/10
Top US
Insurance Companies

50
Global
Insurance
Companies

900
Hospitals
& Health
Systems

8,000
Healthcare Providers

Claims Processing

Removing Complexity and Unifying Stakeholders

Healthcare claims processing is often a needlessly complex web of disparate systems and processes, made even less efficient when handled entirely manually.

PCH Global enables direct communication between payers, providers, patients, and data systems to reduce friction and simplify claims management. Automation capabilities help streamline the full claims life cycle, from enrollments and claims submission, to processing, adjudication, and payments.

Highlights

  • Omni-channel communication support
  • Document digitization and ingestion
  • Integrated rules engines

Removing Complexity and Unifying Stakeholders

Healthcare claims processing is often a needlessly complex web of disparate systems and processes, made even less efficient when handled entirely manually.

PCH Global enables direct communication between payers, providers, patients, and data systems to reduce friction and simplify claims management. Automation capabilities help streamline the full claims life cycle, from enrollments and claims submission, to processing, adjudication, and payments.

Highlights

  • Omni-channel communication support
  • Document digitization and ingestion
  • Integrated rules engines
Claims Processing

Cleaner Claims with Advanced Clinical Editing

Advanced Clinical Editing capabilities allow the PCH Global platform to conduct claims corrections up front, resulting in a smoother processing workflow.

The platform leverages existing EDI pathways, enabling health plans to strategically insert more than 119 million clinical editing and analytics rules into your paper claims workflows with support for multiple lines of business including medicaid, medicare and commercial.

The PCH Global provider portal interface can be integrated with the payer portal, allowing providers to more easily and quickly understand the edits and correct claims.

PCH Global can validate the following types of edits:

  • Clinical Edits
  • Duplicate Edits
  • Prior Authorization Edits
  • Operational Edits (Provider Credentialing)
  • Attachment Edits
  • Administrative Edits
  • FWA Edits
  • Eligibility Verifications


Cleaner Claims with Advanced Clinical Editing

Advanced Clinical Editing capabilities allow the PCH Global platform to conduct claims corrections up front, resulting in a smoother processing workflow.

The platform leverages existing EDI pathways, enabling health plans to strategically insert more than 119 million clinical editing and analytics rules into your paper claims workflows with support for multiple lines of business including medicaid, medicare and commercial.

The PCH Global provider portal interface can be integrated with the payer portal, allowing providers to more easily and quickly understand the edits and correct claims.

PCH Global can validate the following types of edits:

  • Clinical Edits
  • Duplicate Edits
  • Prior Authorization Edits
  • Operational Edits (Provider Credentialing)
  • Attachment Edits
  • Administrative Edits
  • FWA Edits
  • Eligibility Verifications

Prevent Denials

Enable Providers to Clean Their Own Claims

PCH Global’s advanced editing platform returns errors back to providers and improves the speed of claims exception processing by presenting erroneous claims in our online portal for providers to resolve.

When your providers use PCH Global to submit claims images (or resubmit corrected claims), the platform can validate these claims before they enter your adjudication systems, thereby improving your auto-adjudication rates.


Enable Providers to Clean Their Own Claims

PCH Global’s advanced editing platform returns errors back to providers and improves the speed of claims exception processing by presenting erroneous claims in our online portal for providers to resolve.

When your providers use PCH Global to submit claims images (or resubmit corrected claims), the platform can validate these claims before they enter your adjudication systems, thereby improving your auto-adjudication rates.

Prevent Denials
Contact Us

There’s a better way to manage claims.

PCH Global provides a claims processing solution that bridges the gap between payers and providers and automates claims processing to accelerate cycle times and reduce administrative costs.

Schedule a call with one of our consultants to learn more about how the PCH Global platform can integrate with your current systems and processes to improve the way you manage claims.

There’s a better way to manage claims.

PCH Global provides a claims processing solution that bridges the gap between payers and providers and automates claims processing to accelerate cycle times and reduce administrative costs.

Schedule a call with one of our consultants to learn more about how the PCH Global platform can integrate with your current systems and processes to improve the way you manage claims.