Conduent’s HSP comprehensive Core Claims Administration solution is specifically designed for healthcare Payers and Third-Party Administrators. It speeds the processing of complicated healthcare claims by utilizing a broad range of embedded automated tools. We don’t merely assume the burden of your data entry; we apply user-defined rules, workflows and document management tools to optimize the overall process.

The benefits and claims administration solution is built with touch free claims processing in the forefront as the rule and not the exception. The flexible user-definable claims adjudication engine and inherent enterprise workflow supports medical, dental, vision and specialty health benefits administration for multiple lines of business including commercial, Medicaid, Medi-Cal, and Medicare Advantage, all on a single instance of the application. The system automates traditionally manual labor-intensive functions across the enterprise including the management of:

  • Benefit Plans
  • Enrollment and Membership
  • Groups
  • Premium Billing
  • Provider Networks and Contracts
  • Claims Processing and Payment
  • Capitation
  • Authorization and Referrals
  • Enterprise-Wide Workflow
  • Security
  • Reporting & Analytics

The system’s flexible adjudication engine, real-time workflow and the comprehensive database of rules enable highly comprehensive auto-adjudication capabilities that have been proven to optimize claims auto-adjudication rates to exceed industry recommended standards while lowering overall operational costs.

HSP Core Claims Administration allows you to:

  • Gain total control over your health plan data
  • Reduce claims backlogs and expedite claims
  • Expedite HIPAA transaction set, security and PHI compliance
  • Capitalize on new opportunities and simplify Medicare/ Medicaid administration
  • Easily administer and reprice claims for national networks
  • Leverage expert Wizards for processing members, providers and duplicate claims
  • Dynamically create benefit packages for new sales
  • Eliminate redundancy to preserve referential integrity
  • Deploy as needed: at your site, or use our outsourcing services
  • Free yourself from paper and associated cost