Eligibility
The injured worker presents their claim identifying number or employer policy information to the provider.
Provider Access Points
If there is no claim on file, the injured worker or provider can submit a report of injury and request treatment.
The provider enters a code for diagnosis.
From Days to Seconds
Reduce Cost
Data Accuracy
Real-time Application of Business Rules
The medical treatment request is instantly processed via the interface, which uses business rules to adjudicate the transaction following evidence-based medical guidelines. This positively and prospectively impacts the patient’s care (as well as cost) by promoting adherence to medical standards at the point of care.
Payers and providers are also able to communicate in real time regarding additional allowances and disputes, supporting communication flows with legal representatives and external entities such as appeal boards or independent medical review organizations.
Approval & Alerts
90% of medical transactions can be adjudicated in real time using business rules.
10% Unusual transactions are routed to auditors at the payer for immediate review.
The provider is instantly notified of the action.
From Days to Seconds
Clinical Guidelines & Medical Audit
Additionally, alerts notify providers at the point of care (or before) regarding the implications of their care decisions relative to quality metrics, peer performance, and evidence-based / customized clinical guidelines.
Simple Payment
Payment of invoices becomes prompt and simple.
Reduce Cost
From Days to Seconds
Reduce Cost
Key Metrics in Real-time
Indicators & Metrics
Conexia monitors the entire process and generates relevant quality metrics, while the payer has continual and complete oversight of all activity.
Our impact today
20,000,000
BENEFICIARIES
2,000
INTEGRATED PROVIDERS
20,000
TRANSACTIONS PER MONTH
More about our Service Model
At Conexia, we use our deep industry experience to optimize the balance between quality of service for patients, administrative costs and medical costs.
Know more about our Service Model for Workers' Compensation
Put the real-time adjudication solution to work for you
See why Conexia is the leading trusted software vendor in the global payer community.