Medical & Pharmacy Benefits Management Application

Demographic Selection, Clinical Selection, Benefit Plan Certification, Claim Adjudication Analysis, and Integrated Defect Tracking.


End-to-end audit ready traceability


Reduced time to identify and prepare test claims


Increase efficiency identifying root cause for unexpected claim outcomes

Globally Implemented at Fortune 20 Organizations

Product and Managed Services for
  • Defining, testing, and validating claim behavior within an adjudication system for demographic and/or clinical scenarios
  • Augmenting targeted scenarios with randomly selected claims data providing for breadth and depth of testing
  • Comparison and analysis of claim outcomes across source and target benefit plans or adjudication systems
  • Integrated claim analysis with benefit plan configuration
  • Profiling claim outcomes with bulk tagging and tracking capability
  • Intake of benefits
  • Cataloging of benefit plans
  • Versioning of benefit plans
  • Composing benefit plans
  • Reviewing plan components
  • Loading of benefit plans
  • Benefit plan intake & extraction module
  • Benefit plan translations module
  • Benefit plan loading module
  • Benefit plan catalog report
  • Plan components used by a plan report
  • Shared plan components report
  • Impact analysis report
  • Front end technologies such as .aspx or .js
  • Rules engine
  • Rules and benefits database
  • Document parsers and generators
Learn More About GxClaims™