In a typical healthcare encounter today, both the healthcare provider and the patient have limited visibility into how much the patient and the insurance company owe at the time of service. This is because three key components for determining the price of a service – the patient’s insurance policy, the provider network agreement, and the adjudication rules an insurer uses to determine claim payment all reside in siloed data sources. With our DAML solution, both the contracts can be expressed on a single source of truth and the adjudication logic run a priori, effectively creating straight through claims processing.
- Model the lifecycle of a simple outpatient encounter, including a PCP visit, referral to a specialist, appointment creation, and treatment
- View the subsequent claim submission and remittance results