atlhome

So How Does ClaimGen Work?


Source of Truth

ClaimGen’s unique membership translation allows each vendor to act as their own source of truth for matching between claims and membership records. ClaimGen will take in membership records from each carrier, TPA and PBM to create a set of unique matches. All claims that are submitted back and forth will be translated by ClaimGen. Claims processors can rest assured that any claims sent to ClaimGen or coming from ClaimGen will contain native membership so that all claims processors can be the source of truth simultaneously.

Data Translation

ClaimGen allows you to setup one set of formats for each file type. Do you have an existing format for claims, accumulators or eligibility? Great! AccumTech will build plug-ins specific to your formats for the ClaimGen system and all of your files will be handled using those existing formats. In the same fashion, those plug-ins will translate all of your codes into the ClaimGen system.

Connectivity

Your ClaimGen profile is customizable, too! Files can be sent at any time of day and can be sent weekly, daily or in real time – on your schedule. ClaimGen can even be configured to send reports on a separate schedule and to different locations to meet your business demands. This connectivity will be your one-stop for all of your vendors managed through the ClaimGen system and files can be sent separately for each customer or all combined into one file, as needed.

Feed Health

Several of the ClaimGen reports and tools are designed to monitor the overall health of data feeds to provide early detection for problems such as claims falling out of sync, significant increases or decreases in claim volume, and out of sync membership records causing claim translation to fail. So how do we do it?

Monitoring Tools

ClaimGen utilizes a number of tools to ensure data is delivered with reliability and accuracy. Both incoming and outgoing data feeds are constantly monitored for errors, allowing for issues to be resolved with a swift response. If expected claims data is missing or late, ClaimGen has the ability to track and report on this information, ensuring no claims data is ever missed! In addition, ClaimGen verifies that each vendor is posting claims information at a high success rate. Posting success rates and claim responses are tracked by the system and closely monitored by AccumTech analysts, allowing for early detection of issues within the data feed. By detecting and resolving issues early, ClaimGen can help to prevent costly synchronization issues and save vendors the time and energy required for investigating data-related problems.

Reconciliation

The process by which data is accounted for in its final stage between all integrated parties is handled by the AccumTech reconciliation process. Regardless of which service is being integrated, the reconciliation process performed by AccumTech analysts will ensure data being passed between integrated parties is consistent and in sync. Integrated data housed within the vendor systems will be compared against the ClaimGen system to ensure synchronization and consistency between all data points. This process is performed on a routine basis as well as at strategic milestones to ensure consistency is achieved through the life of the integration.

Vendor Relationships

With our suite of tools for monitoring and reporting, we are able to provide the most accurate and up-to-date feedback to our vendors. Armed with this information in hand, we are often able to quickly address an issue before it becomes a large scale problem. Because of this, we are able to garner mutual trust and respect with our vendors. We also work co-operatively with our vendors on projects such as data feed maintenance or resolving a particular claim feed issue to ensure that all possible scenarios are thought of and prepared for. With these vendor relationships bolstered by quality work, preparation, and experience, we are able to proactively approach each new challenge and engage everyone involved to ensure a job well done!


HIPAA Compliance

Accumulation Technologies

Disclaimer

17199 N. Laurel Park Drive | Suite 400 | Livonia, MI 48152 | 1.734.237.5100