Claims processing solutions with automation and analytics

the challenge

Plugging Revenue Leaks in Claims Processing

Medical billing mistakes can result in significant dollar losses for healthcare payers. The ‘pay and chase’ strategy is neither effective nor efficient. Robust revenue cycle management begins with reducing operational and medical expenses, with a special focus on identifying revenue leaks and plugging them immediately. Payers need a modern, digital solution that can not only identify payment errors, but also predict them using existing data at their disposal. These solutions require advanced analytics capabilities that can increase their precision over time and improve overpayment avoidance year after year.

Advance claims analytics and automation solutions

What we do


ApexClaims combines advanced analytics technology in the cloud, proven processes for precise claim assessment, and a team of experts adept at building tailor-made claims analysis solutions for payers. As a result, payers are able to minimize overpayments and reduce avoidable manual touches during the adjudication process.


Automatic Bang for your Buck

ApexClaims delivers significant efficiencies:

reduction in the number of touches
review of claims
reduction in rework/re-routing
improvement in error identification vs. manual process
reduction in manual intervention
for single-touch claims
basis point improvement in claim accuracy

Our approach

Advanced Analytics and Automation

ApexClaims uses classification and anomaly detection models to accurately predict financial leakages.

Key capabilities include:

Claims administration

Claims Administration

Use AI-backed insights to highlight improvement breakthrough opportunities in pre- and post-payment processes. Manual touch reduction gets it right the first time, while proven claims processing and audit build better compliance.

Drive member management

Member Management

Drive member management systems easily and efficiently with automation. Push for higher star ratings, increase member satisfaction, and maximize enrollment.

Automation to manage impaneled provider networks

Provider Network Management

Use automation to manage impaneled provider networks at scale with credentialing services, contracting, and improved process tracking and reporting.

Risk coding

Risk Coding

Leverage machine learning models to identify risks and adjust according to Hierarchical Condition Category (HCC), which assesses expected medical costs based on a proven scoring system.

ApexClaims in Action

Healthcare Revenue Management Firm Reduces Denials by 95%

ApexClaims helped a healthcare firm save costs and reduce denials with an RPA-enabled claims processing system.

Healthcare Payer Saves Overpayments Worth $1.5M per Annum

ApexClaims helped a US-based healthcare payer intelligently adjudicate claims and predict likely overpayments with 99.7% accuracy.