Claims & Encounters
Accelerating claims processing through automation
and comprehensive administration.
Acentra Health's evoBrix X™ system supports electronic data interchange (EDI) and paper submission for
professional, institutional, and dental claims and encounters. Our processing enable administrators to oversee enrollment and
view capacity by service area and contract through data with our platform, evoBrix X™. Administrators can more easily process
exceptions, manage contracts, fine-tune rates, submit edits and adjustments, and view overall payment summaries to clients
and providers. Our automated adjudication engine can be tailored to your program's needs and can send processed claims
for payment and flag claims needing further review.
evoBrix X™ has consistently earned CMS certification, back to day 1 of operations, with zero CMS findings and
was the fastest MMIS implementation timeline.
1.8
Claims processed
annually
98
Claims auto
adjudicated
5.4
Providers utilize
our claims system
Quickly Process Claims and Accurately Track Encounters
evoBrix X™ automatically validates claims and encounters by comparing their data to a comprehensive claims reference database. The system allows transactions to be processed with precision, sending payment justification documents to providers automatically. evoBrix X™ empowers your team to determine and maintain benefits, service areas, schedules, and performance indicators for your program. You can evaluate and administer contracts, rates, capacity, enrollment, schedules, capitation payments, and more.
Fast, flexible, and efficient, evoBrix X™ unites regulatory policies with program specifications on a secure, modular, scalable platform to process billions of claims and payments for participants annually.
Secure, Protected Participant Data Intake, Visualization,
and Reporting Aligned with MITA Standards
Access a variety of
pre-populated reports that can be
customized to your needs
Configure care services, enrollment,
and payments with a business process
wizard to reduce redundancies
Set prior authorization criteria to flag
high-risk claims for additional review
before payment
Modify contract rules, including
carve-out services and FQHC/RHC
capacities
Automate rate factor changes and
calculations for nimble adjustments to
program payouts
Core Claims and Managed Care Module
The Core Claims and Managed Care module seamlessly accommodates both Medicaid Fee-for-Service (FFS) and managed care scenarios. Built on the powerful evoBrix X™ platform, the module is designed for volume and performance demands of large-scale claims and encounters processing and payments.
Benefits:
- Combine transactional data, analytics, and intelligent workflows for clear oversight
- Create automated workflows in our purpose-built rules engine that make approval, suspension, and denial decisions in seconds
- Generate 820 and 834 HIPAA X12 mandated formats for managed care plan enrollments and benefits, as well as 834 HIPAA X12 mandated formats for remittance advice
Claims Adjudication
Acentra Health's rules-based engine provides a CMS-compliant framework to automate adjudication processes. This allows simple, no-code entry of new and updated claims processing rules created from policy, mandates, and program-specific business logic. As a result, administrators can incorporate policy changes in a timely manner to meet legislative needs. Moreover, the rules engine has the capability to shadow price encounter claims to allow for better oversight of managed care contracts.
Benefits:
- Establish checks prior and during the validation phase to actively prevent denials
- Verify member and provider eligibility to ensure approval of genuine claims
- Avoid cost recovery from duplicate claims and service/benefit conflicts
- Contains thousands of pre-configured business rules, pricing rules, industry standard edits, and audits
Managed Care Administration
and Encounters Claims Processing
Acentra Health's evoBrix X™ technology performs accurate, rapid encounter claims processing. Our team of technology professionals design our managed care program administration solutions to adhere to current requirements and your future needs. Your administrators can view impacts to enrollments and capitation payments as potential updates occur to programs, contracts, and rates.
- Alleviate administrative burden: enable self-service, reduce paper, and improve revenue cycle times
- Lower development and maintenance costs with low-code to no-code configuration management
- Create service-based enhancement payment configurations to improve provider relationships
- Give eligible members enrollment choices and re-assignment options to increase overall satisfaction
Approved Supplier Partner Of NASPO ValuePoint
Acentra Health is a supplier partner of the MMIS Provider Services and Claims
Processing and Management modules for state Medicaid programs.
What Our Partners Say About Acentra Health
"We needed to replace outdated technology, which was inefficient to modify and had high maintenance and operation costs. We are pleased to have met our goal of implementing a new solution quickly with very little disruption to our providers and appreciate the dedication of the state staff working on this project with [Acentra Health]."
— Teri Green | State Medicaid Agent and Healthcare Financing Division Senior Administrator, Wyoming Department of Health
"The [Acentra Health] team has consistently provided fantastic service and support throughout numerous initiatives. Not only did they complete required tasks on time, they also proactively identified a business need and delivered new visualization data to help us better track encounter data submissions. [Acentra Health’s] commitment and dedication to the CMS mission is evident and much appreciated."
— Contract Office Representative, Centers for Medicare & Medicaid Services (CMS)
"With this full approval from CMS for [the evoBrix™ Provider Management module], AHCCCS [Arizona] and Med-QUEST [Hawaii] are now poised to be able to streamline the provider enrollment process, improve the providers’ user experience, and eliminate previous manual enrollment processes. Moving to this cloud-based solution is one more step toward modernizing the technology we use to provide health care services to the nearly 2.2 million Arizona residents and 430,901 Hawaii residents enrolled in Medicaid.”
— Kristen Challacombe | AHCCCS deputy director of business operation
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