More Automated, More Accurate Payment

Increasingly complex plans, plus more and varied lines of business, can push healthcare payers' claims payment systems beyond their ability to deliver the necessary speed and accuracy. ClaimsXten™ is a durable, flexible solution for clinically-based claims auditing that offers flexible rules creation and firing that enable payers to process each claim under the specific terms and conditions of each benefit plan.

ClaimsXten combines the strength and flexibility of the McKesson Total Payment™ platform, a comprehensive library of McKesson clinical rule content, and a services team of medical claims experts to provide your organization with more medical and administrative savings opportunities. With full-service, technologically advanced ClaimsXten, you can do much more than standard fee-for-service claim code editing.

Providing Flexibility to Increase Efficiency

With ClaimsXten, you can apply edits to claims at any point in your workflow. This means you can automate and manage the unique requirements for varied claims management policies and medical payment policies. Delivered as a full service ASP solution securely hosted by McKesson (or customer-hosted with a customized service path), with ClaimsXten you can:

  • Increase your auto-adjudication rates
  • Adjudicate ICD-10 claims with rules that look at historical claims coded in ICD-9
  • Consistently and accurately apply your policies - across plans, regions and claims processing systems
  • Pay claims more accurately while reducing administrative costs
  • Shift processing burdens to extend the useful life of your claims processing system(s)

Providing Comprehensive Clinical Editing Content

Our continuously growing body of clinical editing rules, along with the extensive rule customization flexibility of ClaimsXten, help you manage medical and payment policies across all lines of business and for both professional and facility claims. In addition to the standard industry edits, the seasoned McKesson Clinical Team also develops and maintains clinically sound, sourced rules specifically covering the following areas:

  • National Coverage Determination/Local Coverage Determination
  • CMS-Sourced
  • Medical Policy
  • Waste and Abuse themes
  • Specialty Pharmaceuticals
 

Do you want to know more about ClaimsXten or our Total Payment solution? Request more information.