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How We Do What We Do


AccumTech's main goal is to create a smooth claim transition from one vendor to another. This means using state-of-the-art technology and the newest techniques to import, reformat, translate and forward claims seamlessly and using formats & codes that are native to the sending and receiving vendor.

Creating custom formats for each vendor interface can be costly and time-consuming. Using AccumTech's ClaimGen system means that connectivity, file formats and coding only need to be setup once. Once setup with the ClaimGen system, adding new customers to the regular feed is as simple as sending the group codes and beginning to forward claims and membership data.

In short, ClaimGen simplifies and enhances the claim sharing experience.


So How Does ClaimGen Work?

process

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 are designed to monitor the overall health of data feeds to provide early detection for problems such as:

  • Claims are falling out of sync
  • Claim volume has decreased or increased beyond normal levels
  • Membership records are out of sync and claims cannot be translated

All claims are processed through ClaimGen’s central repository where they are reviewed and stored. This allows them to be sent to any vendor once they are filtered through that vendor’s plug-in.


HIPAA Compliance

Accumulation Technologies

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