Accelerate speed to insights
Leveraging cutting-edge AI, cognitive technology, and data-driven analytics, the EXL Smart Platform for Health delivers comprehensive intelligence that allows subject matter experts to rapidly synthesize value from big data to detect anomalies in a real-time, modality-agnostic capacity throughout the claim continuum. By continuously monitoring and analyzing claims data in real-time, our platform empowers healthcare providers and payers to identify and address potential irregularities promptly, thus streamlining operations and enhancing overall payment accuracy.
How is EXL Smart Platform for Health different?
Enables pre-payment complex claim reviews with speed and accuracy
Selects claims with high precision to ensure billing and payment accuracy to maintain the financial fidelity between member, health plan and provider
Identifies all potential anomalies associated with a particular transaction to streamline review process
Detects anomalies across the entire claims continuum from prior authorization through post-payment review/recovery
Delivers faster transparency for both payer and providers to enable intervention with minimal disruption to operational and financial workflows
Integrates with payer systems easily, including real-time API and batch transactions and requires minimal effort on time and resources.
EXL Smart Platform for Health features:
- Scalable cloud storage and architecture: Leveraging Microsoft’s Azure Delta Lake technology, data is taken through an intelligent data engineering process to ensure the highest level of cleansing and accuracy
- Data science workbench: The unified environment combines access to the best available data and automation capabilities tuned to spot billing and payment anomalies accurately in real time
- Real-time anomaly detection rules engine: At any point within the claim continuum the solution can identify and detect anomalies, while also reducing false positives and increasing accuracy. The canonical data model delivers intelligent claims routing to automate and triage data needs, while allowing data exchange between different systems, agnostic of the claim type or submission source, or technology used
- Low code/no code configuration: Everyday SME users can configure rules and automate workflows without engineering support. This enables stakeholders to quickly address concerns, trends, and anomalies, accelerating the speed to insights and extracting value from data