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Zyter Claims Manager™ for Healthcare Payers

Streamline and Automate Claims Processing

Fast and accurate claims processing is a challenge for payers as the number of Medicare and Medicaid plan members grows steadily, especially for payers that still rely on legacy systems for claims processing. Moreover, the manual review of claims with processing errors lowers the daily claim adjudication rate and delays the decision to pay in full, deny, or partially pay a member’s claim. The result – increased costs for payers, slow reimbursement to providers, and a potentially negative provider/member experience. Payers gain the processing efficiency and end-to-end visibility they need with Zyter Claims Manager™.

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A highly configurable and scalable solution, Zyter Claims Manager offers automated, high-volume claims processing while giving payers the advantage of reducing manual intervention and streamlining claims adjudication. The application integrates easily with all payer systems, including legacy systems, to deliver a cost-effective solution for streamlining claims processing.

Fix Errors in Real-time. Reduce Adjudication Time and Costs.

fix errors in realtime

Zyter Claims Manager gives payers unprecedented visibility and tracking of claims throughout the claims lifecycle – including real-time visibility and automated reprocessing of errors. Using the Zyter Claims Manager dashboard, claims staff can catch and fix format processing errors faster – before claims are submitted for adjudication – to reduce the time, effort, and costs of manual intervention. Zyter Claims Manager also drives the following capabilities to help payers ensure fast and accurate claims processing:

Support for High-Speed Processing – Zyter Claims Manager supports high-speed processing of multiple claims without degrading system performance. Zyter’s seamless integration capability makes claims processing even on older, homegrown legacy systems more efficient.

Scalable for the Future – Payers can process hundreds of thousands of claims per day and be ready for future growth as the Zyter EDI platform has the scalability to accommodate any size of claims volume as payers increase their membership numbers.

Assurance of State and Federal Compliance – In addition to meeting HIPAA requirements, Zyter’s support for high-speed processing and faster turnaround of claims helps to improve the payer’s ability to meet all state and federal mandates for timeliness of claim payments.

Improved Member Experience – With Zyter Claims Manager, payers can ensure a better member experience by streamlining claims processing and significantly reducing any errors or delays in payments.

Zyter’s Automated EDI Platform Improves Speed and Accuracy

Payers can gain efficiencies throughout the claims processing lifecycle – and achieve a higher adjudication rate with the following automated EDI features:

Automated and Streamlined EDI Workflows – Zyter streamlines claims management and related EDI workflows with automated technology and microservices, resulting in improved scalability and performance with less human interaction.

Rich User Experience (UX) Interface and Dashboards – Use the dashboard to view transactions and process edits, as well as assign work, fix and reprocess errors, and perform other EDI management actions. View submitted files, accepted/rejected files, approved/denied amount, error files, and reasons for errors as well as use the correction feature. The dashboard also provides an individual view of claims with status and an audit report of claim correction by analyst.

Real-Time Error Workflow – Zyter Claims Manager identifies errors in real-time and automatically routes them to claims staff for correction and reprocessing on the Zyter Dashboard. Support for Multiple Documentation Formats – Processes all standard and state-specific claims forms, plus transforms any other document format, including scanned or digitized forms, to reduce the occurrence of processing errors.

Rules Engine for Expedited Claims Processing – Rules can be customized by state to validate claims for fast, efficient processing to meet all state-specific and federal format requirements and timeframes. Includes a built-in validator for HIPAA SNIP L1-L7 validations and custom rules for EDI systems.

Coding Updates – Coding updates for CPT, ICD-10-CM, and HCPCS level II classification. Claims Status and Format – Load CCLF claim format and get real-time claim status.

Add Value to Claims Processing and Adjudication

Zyter Claims Manager benefits payer organizations in the following ways:

  • Increase speed of claims processing for higher operational efficiency
  • Reduce the time and costs of manual intervention for claims adjudication
  • Process hundreds of thousand claims per day and scale up for increased volume in the future
  • Reduce IT costs with seamless integration of a cloud-based solution
  • Ensure a better member experience by eliminating delays in claim payments
  • Stay competitive and responsive to members’ future needs with next generation EDI technology

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