Claims modernization and automation for insurance and healthcare
We rebuild aging claims platforms and automate the paperwork around them, from correspondence to payment matching, for teams that can't afford a day of stopped claims.
- Claims platform rebuilt and extended for 3+ years
- AI document processing live in production
- BAAs signed where required
Built for claims operations
Especially teams running on a claims platform built 10 or more years ago.
- Claims administrators
- Third-party administrators
- Insurers
- Workers' compensation carriers
- Pharmacy-claims businesses
Where claims operations lose time and money
- A core platform the business has outgrown, that nobody can safely change
- Remittances, EOBs and lockbox batches matched to claims by hand
- Correspondence that covers several claims at once, sorted and keyed manually
- Zero-pay and short-pay handling tracked in notes nobody can report on
- Audits and health-data rules that make every shortcut risky
What we do for claims teams
Five ways in, each built into the platform you already run or the one we rebuild.
Modernize the claims platform
Rebuild legacy systems on .NET and SQL Server, with parallel running before cutover.
Legacy application modernizationAutomate document intake
Correspondence and payment documents become validated claim data, with people reviewing exceptions.
Intelligent document processingAutomate payment matching
Electronic payment files (835s) and lockbox batches processed and allocated automatically.
Standardize the data
Response codes, work queues and audit trails that make reporting reliable.
Connect the systems
Payers, pharmacy benefit managers, banks and accounting, through files and APIs.
We already know the vocabulary
You won't spend the first month teaching us your business. Our teams have built and run features for all of these.
- Claim receipting
- Allocation
- 835 remittance files
- EOBs
- Lockbox batches
- Zero-pay claims
- Short-pay claims
- Response codes
- National Drug Codes
- Correspondence batches
- Collections work queues
- Accounts payable
- Liability calculations
- Pharmacy contracts
Careful with health data by default
- HIPAA-aware handling of protected health information, and BAAs signed where required
- Processing inside your own cloud environment
- No health information accepted through our website
- Least-privilege access and a full audit trail on every system we build
Deciding what to do with an aging claims system?
Our guide covers what a claims platform must handle, and how to choose between buying, building and modernizing.
Claims modernization FAQ
Can you modernize our claims platform without stopping claims?
Yes. We rebuild in phases and run the old and new systems side by side before cutover.
Do you work with health information?
Yes, under a BAA where required, with processing in your own cloud environment.
Can you add automation without replacing our system?
Yes. Document processing and payment matching can be built into the platform you already run.
Do you only work in workers' compensation?
No. Our deepest experience is workers' compensation pharmacy claims, and the same approach applies to other insurance and healthcare claims operations.
Talk to a team that already knows claims
In a 30-minute call with our CEO or CTO, we'll talk through your platform, your paperwork and where automation would pay off first.
- Your platform and where claims slow down
- Which automation would pay off first
- What a phased plan would look like