With OpenSpan's Claims Automation service, you can support the process improvement life cycle by iteratively… Discover how users work by monitoring user application navigation and data entry and events to see what users actually do; measure user work processes by analyzing user events to correlate and understand how users work; and ultimately improve how users work by automating user processes – increasing user capacity, efficiency and process compliance, while driving cost out of the business

1. a better way to workTM
for Healthcare

2. Approach for Health Payers
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3.  Replicates a high percentage% of existing processes being performed manually
 Decreases cost - reduces the number of claims requiring a human to process
 Utilizes your existing applications and current claims processes
 Low IT and business resource footprint
 Offers value in 30 days and fully implemented in less than 6 months
 Provides near-immediate triple digit ROI
Emulate the observations, decision and actions – or more simply, the
eyes, brains and hands – of your claims examiners.
Access the data necessary to settle a claim without requiring IT
resources to build services, provide APIs or develop extracts.
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Overview

4. Solution Lifecycle
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5. 7
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Implementing the Claim Automation Service
Your numbers may vary

6. Use Case Examples
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 Pre-X
 Wellness
 Duplicate Checks
 Provider Management
 Prompt Pay
 Authorizations
 Adjudication Edits
 Pricing Overrides
 Capitation
 Tiered Benefits
 Corrected Bills
 Coordination of
Benefits
 Processing Paper
Claims
 Claim Status Checks
 Policy-level Checks
 Large Claim Review
 Claim Audit
 Data Quality Checks
 Data Formatting
 Out of Network
 Provider Updates
 Medical Record Review
 Auto Log In & Refresh
 Customer 360
 Transferred Call Data Share
 Caller Verification &
Disclosure
 Application Set Up
 Application Synchronization
 Previous Call History
 Real-Time Guidance
 Process Simplification
 Validations
 After Call Notation
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7. Engagement Path
• Client pain point
• Benefits assessment
• Technology diligence
• Proof of concept
• Prioritize automation opportunities
• Build and implement claim automation service
• Build and implement claim optimization
• Build and implement contact center optimization
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OpenSpan Investment in
business relationship with client

8. OPENSPAN PROPRIETARY & CONFIDENTIAL