Healthcare Claims Repair: The "Smart" Approach to Claims Adjudication

Built on Pegasystems' market-leading business process management (BPM) platform, the Claims Repair solution empowers existing systems with greater intelligence. Specific business rules are integrated with industry best practices to ensure claims adjudication occurs automatically, consistently, and cost-effectively.

Pegasystems' Claims Repair solution uniquely combines an organization's business rules with out-of-the-box, best-practice templates for claims processing. Using this application, an organization can automate its claims process from preadjudication through claims fi nalization, easily making real-time process changes. Claims Repair is a comprehensive solution that is easy to implement and built for the evolving payer environment Claims Repair can help increase the first-pass rate, eliminate backlog, and dramatically reduce operational and IT expense.