• Lexmark International, Inc., a global technology leader, today launched Kofax Claims Agility™, an ICD-10 compliant software solution that automatically processes institutional and professional medical claims and supporting documents. It 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.
• Kofax Claims Agility 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.
• This new solution solves 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.
• Kofax Claims Agility accelerates claims automation projects for health insurance carriers, property and casualty insurance companies processing injury claims, large healthcare providers and third-party administrators. Designed to process medical claims quickly and efficiently, Claims Agility is built on the TotalAgility® smart process application platform that 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. Customers can also take advantage of 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.
“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,” said Reynolds C. Bish, vice president, Lexmark and president, Enterprise Software. “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.”
Industry experts expect to see a multitude of denied charges for coding and billing errors when the industry changes to ICD-10 on October 1, 2015. When diagnosis codes change to more specific coding, there may be mismatches with medical necessity and provider payment guidelines. Payers have not changed or may not have released their payment determinations for the new codes.
The Centers for Medicare and Medicaid Services has warned that denial rates could increase 100% to 200% in the early stages of ICD-10 implementation.
Lexmark (lexmark.com) creates enterprise software, hardware and services that remove the inefficiencies of information silos and disconnected processes, connecting people to the information they need at the moment they need it.
Lexmark, the Lexmark logo, Open the possibilities and Kofax Claims Agility are trademarks and TotalAgility is a registered trademark of Lexmark International, Inc., registered in the U.S. and/or other countries. All other trademarks are the property of their respective owners.