ClaimDox is a dynamic auto-adjudication and valuation system that helps payors and providers to simplify the processing of their EDI-transmitted and paper-based claims by automating the adjudication process to ensure consistent and accurate pricing in less time and with greater oversight.

This specialized solution integrates with your existing eligibility, pricing and/or claims processing systems to quickly and precisely compute reimbursements and exceptions according to your individual provider contracts, removing individual interpretation and administrative bottlenecks.

ClaimDox boasts a number of effective features to deliver fluid and practical business processes. These include: 

Integration and Compatibility  

• Integration with your existing databases and software
  
• Ability to extract data from paper-based CMS1500, UB92 and ADA dental claim forms. Using ScanDox, our rules-based document imaging and routing systems
  
• Automates the pricing of any type of claim, regardless of contract complexity
  

Customization

• Each contract is electronically interpreted and programmed into the adjudication engine, removing payout ambiguities and creating a foundation for automation
  
• Determine the level of manual intervention, such as queuing adjudicated claims for administrative review
  
• Scanning can be performed locally at your facilities or remotely by IDS
  

Process Automation

• Automatically archives digital copies of scanned claim forms and supporting documentation while converting printed information into electronic data using OCR
  
• Make changes to your database of contract and payout terms in real-time without affecting other steps in the adjudication process
  
• ClaimDox can distinguish between various contract types and apply the appropriate rules to determine the correct reimbursement amount
  

ClaimDox simplifies the time-intensive adjudication and valuation process in five (5) steps:

(Move your mouse over each section of the diagram below for an explanation)

ClaimDox users report a number of administrative, financial and competitive benefits, including:

• Increases capacity while reducing overhead and repetitive tasks
• Increased accuracy and controls for managing overpayments and fraudulent claims
• Improved ability to oversee and track claims
• Greater compliance with state prompt-payment laws
• Improved turn-around time on claims
• Detailed explanation of payments for addressing disputes