EXL Smart Platform for Health
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
Featured insights
Solution sheet
EXL patient engagement platform
Solution sheet
EXL patient engagement platform
It takes patient cooperation to improve healthcare outcomes and enhance quality in today’s cost-conscious, value-based healthcare industry. And, while many programs have been introduced that connect patients with providers for the sake of measuring outcomes, the inability to consistently motivate patients to do the “right thing” persists.
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Solution sheet
It takes patient cooperation to improve healthcare outcomes and enhance quality in today’s cost-conscious, value-based healthcare industry. And, while many programs have been introduced that connect patients with providers for the sake of measuring outcomes, the inability to consistently motivate patients to do the “right thing” persists.
Solution sheet
Making complex government reporting scalable – yet custo...
Solution sheet
Making complex government reporting scalable – yet customizable
Government reporting is a herculean task for healthcare systems. Consider the following: To stay in compliance with regulations and optimize revenue, healthcare systems typically are responsible for completing and submitting hundreds of government reports – some on a yearly basis, others quarterly, monthly, or even weekly.
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Solution sheet
Government reporting is a herculean task for healthcare systems. Consider the following: To stay in compliance with regulations and optimize revenue, healthcare systems typically are responsible for completing and submitting hundreds of government reports – some on a yearly basis, others quarterly, monthly, or even weekly.
Solution sheet
Together, we will do this.
Solution sheet
Together, we will do this.
Human Ingenuity is the catalyst with which EXL Health solves your complex problems. We combine our extensive patient-, consumer-, and HCP-level data assets, advanced analytics methodologies, and domain expertise to find better ways to discover and keep patients on your therapies.
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Solution sheet
Human Ingenuity is the catalyst with which EXL Health solves your complex problems. We combine our extensive patient-, consumer-, and HCP-level data assets, advanced analytics methodologies, and domain expertise to find better ways to discover and keep patients on your therapies.
Solution sheet
Whole person health risk
Solution sheet
Whole person health risk
Social and clinical comorbidities are an inescapable reality of healthcare. Almost 80% of health outcomes are related to social and environmental aspects*. Even with the increased awareness, and tools in the market, payers, providers, and community organizations struggle with data access and interoperability challenges.
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Solution sheet
Social and clinical comorbidities are an inescapable reality of healthcare. Almost 80% of health outcomes are related to social and environmental aspects*. Even with the increased awareness, and tools in the market, payers, providers, and community organizations struggle with data access and interoperability challenges.
Reports & research
A Leader in 2023 Everest Group PEAK Matrix® for Payer Op...
Reports & research
A Leader in 2023 Everest Group PEAK Matrix® for Payer Operations
EXL Achieves Leader Designation in the Everest Group Healthcare Payer Operations PEAK Matrix® Assessment 2023.
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Reports & research
EXL Achieves Leader Designation in the Everest Group Healthcare Payer Operations PEAK Matrix® Assessment 2023.
Case study
Digitally-enabled data mining approach expands scope of ...
Case study
Digitally-enabled data mining approach expands scope of audit opportunities
A major U.S. healthcare payer was seeking improved results from its payment integrity program, specifically its data mining practice. Unlike a clinical claims audit that challenges how a provider billed a claim, data mining is used to determine if a claim was paid correctly.
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Case study
A major U.S. healthcare payer was seeking improved results from its payment integrity program, specifically its data mining practice. Unlike a clinical claims audit that challenges how a provider billed a claim, data mining is used to determine if a claim was paid correctly.