Benefits
LexisNexis® ClaimCleanse™ is a hosted provider data validation and correction service for in-stream claim processing. It makes it simple to determine whether submitted provider information on a claim is accurate, current and valid, reducing the need for costly manual intervention.
Benefits:
- Avoid provider and financial data inconsistencies between the claim submission and the provider file
- Reduce errors in claims payments
- Enhance ability to identify potentially fraudulent submissions
- Lower the chance for inaccuracies in data warehouse reporting and analysis
Features
LexisNexis® ClaimCleanse™ is powered by the Master Provider Referential Database, containing accurate and up-to-date information on 6.5 million health care providers. This works in tandem with our proprietary AcuSync®, algorithms that automatically correct errors as well as missing fields.
Features include:
- Customizable business rules, allowing the user to set specific preferences at the claim field level
- Operating capability in either real-time or batch processing mode to fit the pace of any claims processing cycle
- Identification of discrepancies between rendering and billing in key fields on both the file and the claim for quick correction/repair
- Enhanced auto-adjudication and more accurate matches to the internal provider file
- Notification of potentially fraudulent submissions on a claim-by-claim basis