, you can execute rapid testing for product builds using your benefit designs and test claims all seamlessly working together.
The time savings are nothing short of revolutionary—what used to take weeks can now be accomplished in mere minutes. But it’s not just about speed; it’s about precision. ClaimOptima is designed to eliminate human errors and even self-correct as it learns, ensuring unparalleled accuracy.
ClaimOptima gives you the ability to upload your product benefits directly into the system. Forget about setting up individual test cases; all you need are claims that represent the range of services you both cover and non-cover. ClaimOptima will automatically match these against the uploaded benefits, flagging any discrepancies instantly.
If a behavioral health out-of-network claim is paid at 90% coinsurance when it should not be covered at all, ClaimOptima will catch it. This level of automation allows you to sift through a large volume of claims rapidly, whether they are test claims or actual production claims experiencing issues.
Whether you’re in the pre-production phase or troubleshooting existing plans, ClaimOptima offers the versatility to meet all your benefit testing needs.
Using this proprietary technology for our consulting efforts led to high customer demand for ClaimOptima. After witnessing the speed and quality of the results, the platform was made available for commercial use. SourcEdge serves as a trusted technology solutions partner helping health plan CIOs and VPs modernize and maintain their claims and business systems. We bring modern tools and talented people to every initiative helping health plans serve their members / patients and providers.
The unified organization combines SourcEdge’s claims system technology optimization expertise with Alivia’s AI-powered payment integrity / FWA data and analytics platform.
