Payers are seeing claims volumes and system integration needs grow exponentially year upon year, while audit staff struggle to identify and act on potential improper claim payments. EXL’s proprietary workflow application EXLMINE™ is a robust digital business process automation tool designed to help by centralizing all functions needed to manage the entire life cycle of an audit.
EXLMINE™: An end-to-end audit workflow management platform
Claims auditing is a core function of health plan payment integrity operations, but many payment integrity departments lack the ability to track and manage inventory effectively, and others struggle with disparate processes or workflow solutions that require custom builds and integration workarounds into claims platforms.
Our proprietary workflow application, EXLMINE™, is a robust payment integrity system, supporting both pre-payment and post-payment modalities, and is designed to help audit staff to identify, manage, and act on potential improper claims payments. The system improves effectiveness and efficiency by centralizing all functions needed to manage the entire life cycle of an audit from data intake to overpayment recovery to reconciliation and reporting.
EXLMINE™ helps our customers to become more efficient and drive deeper and more meaningful savings.
- Central inventory platform provides auditing system of record to effectively and efficiently identify insights and manage activities
- Customized configurability to your specific program needs to deliver superior performance, maximum savings, reduced operating costs, and increased accuracy
- Sophisticated reporting capabilities, delivering real-time access and transparency into operational processes and activities
Delivering $1 billion in savings for a Fortune 500 health plan with EXLMINE™:
EXL Health and our health plan client began our partnership over two decades ago, and since then, have steadily expanded the breadth and depth of our services to include multiple large-scale payment service programs and the EXLMINE™ platform. The client leverages EXLMINE™ to support both pre- and postpay claims modalities, with medical record based clinical audit services including in-patient, outpatient and specialty services. The client currently has over 600 auditors on EXLMINE™, which has been configured and customized to support their workflows, and includes reporting and branding in their own custom correspondence templates.
EXLMINE™ and EXL Health’s payment integrity services have been able to support the client and their claim audit needs through multiple initiatives, resulting in $1 billion in savings.
EXL Health payment integrity
At EXL Health, we believe in a modular approach to payment integrity, allowing our customers access to the right software, analytics, people, and processes to transparently identify and address overpayments, trends, and unique business challenges. Our innovative approach provides payers deeper insights into their payment integrity program through transparent and accessible information, resulting in reduced costs, improved payment operations, and accelerated savings recognition.
EXL Health recognizes the need for digital enablement at every phase of a payment integrity program and uses innovative technologies to select more claims with greater accuracy, capture greater savings volumes, and improve operational productivity.