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Lexmark (Lexington, Ky.), has launched Kofax Claims Agility, which the vendor describes as an ICD-10 compliant software solution that automatically processes institutional and professional medical claims and supporting documents. Kofax Claims Agility captures, extracts and validates all patient, provider and service line data, identifies invalid medical codes and enables knowledge workers to quickly review or correct errors and to accept, escalate or deny claims as appropriate, according to a vendor statement.
The new solution addresses the challenges created by the scheduled adoption of changes to ICD-10 on Oct. 1, 2015. Industry observers expect greater specificity in diagnostic codes to lead to a massive increase denied charges for coding and billing errors, according to Lexmark. Mismatches are expected between specified codes and medical necessity and provider payment guidelines, as insurers may have failed to change or release payment determinations for the new codes.
Reynolds C. Bish, VP, Lexmark.
“Claims Agility empowers claims processors to make smarter, earlier decisions about claims by automatically capturing, extracting and validating all patient, provider and service line data, and enables knowledge workers to quickly review and correct errors,” comments Reynolds C. Bish, VP, Lexmark. “Claims are converted into standard EDI files and directed to downstream adjudication processes, thereby increasing operational efficiency, reducing cycle times and costs, ensuring compliance and improving customer service.”
Replacing Manual, Paper-based Processes
Kofax Claims Agility is designed to solve the overwhelming paper challenges insurers face due to the influx of more than 15 million people brought into the healthcare system through the Affordable Care Act, which has resulted in an estimated 190 million new claims, with an estimated 15 million of those being paper-based, the vendor says. The new solution replaces manual, paper-based processes with a complete digital solution, improves operational efficiency, and speeds identification of problematic claims and resolution with providers. It also enables validation workers to make a more informed decision about the next appropriate action, expedites the transition of ‘clean claims’ and corrected claims into the downstream adjudication process, and reduces the cost of claims processing, Lexmark says.
Kofax Claims Agility also accelerates claims automation projects for health insurance carriers, property and casualty insurance companies processing injury claims, large healthcare providers and third-party administrators, Lexmark asserts. The is solution is built on the vendor’s TotalAgility smart process application platform that Lexmark says enables organizations to quickly integrate with back-end systems, create new processes that fit their environment, and monitor, analyze and improve system and user performance through operational analytics. The solution offers customers additional functionality contained in the TotalAgility platform, including customer communications management, information integration, mobile, and e-signature, and leverage these capabilities at any point in the process to minimize workflow gaps and maximize provider and subscriber satisfaction.