A State-of-the-art Claims Inventory Management Solution
With legacy inventory and performance management capabilities, healthcare payers must often rely on manually intensive processes when handling shifting priorities.
Navigator for ClaimsSM replaces various, less efficient, health plan-developed solutions and reports used to distribute inventory. The product goes beyond work distribution by supporting performance management through intelligent workflows that streamline processing, progression and operational management of pended claims inventory.
Navigator for Claims is NASCO’s state-of-the-art claims inventory management solution. Built on Pegasystems’ industry-leading Claims Workstation Framework, Navigator for Claims enables healthcare payers to increase efficiencies by optimizing pended claims inventory management. This product offers performance management and skill-based work distribution capabilities that increase productivity by reducing the amount of time required to resolve claim edits.
The innovative business process management technology within Navigator for Claims improves processing accuracy and increases speed to market. The product’s intuitive user interface empowers business users to configure rules and service-level agreements to appropriately manage claim queues. It also automatically identifies claims linked to performance guarantees and enables health plans to manage the performance of those claims to reduce payout risks. In addition, the real-time ability to adapt claims rules through health plan-administered tables allows healthcare payers to adjust their process immediately when changes occur.
Navigator for Claims has been tailored to support a comprehensive portfolio of healthcare payer business. In addition, Navigator for Claims automatically distributes claims based on the claims’ priority and processor skills, which prevents processor-driven claims selection. The product is also able to auto-route highly complex claims to specialized teams. These capabilities enable Navigator for Claims to get the work into the right hands at the right time to deliver optimal efficiency, quality and value to our health plan customers.
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NASCO is continually innovating. We are developing new products, improving capabilities and increasing sharable services to ensure that our health plan customers remain competitive and aligned with changing market demands.