a better way to workTM

for Healthcare

Approach for Health Payers

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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.

OPENSPAN PROPRIETARY & CONFIDENTIAL 4

Overview

Solution Lifecycle

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Implementing the Claim Automation Service Your numbers may vary

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

OPENSPAN PROPRIETARY & CONFIDENTIAL

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

OPENSPAN PROPRIETARY & CONFIDENTIAL