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Overview

Claims Services and Solutions combines 25+ years of expertise with state-of-the-art IDP and Digital Mailroom products. We manage the full lifecycle for leading US Healthcare Payers, normalizing EDI, portal, mail, and fax inputs to prevent errors. Our configurable rule libraries enforce eligibility, coding, duplicates, COB, pricing, contracts, accumulators, and medical policy—ensuring every claim is handled with automation guided by human oversight.

Supporting Large, Mid, and Small Group Commercial and State/Federal plans, our AI-powered Automated Claims Solution (ACS) accelerates adjudication across legacy and homegrown platforms. Backed by 1,000+ professionals and 100+ SMEs, we manage $30Bn+ in annual value with 99.8% accuracy while identifying suspect and fraudulent activity.

Unified Intake via IDP

Unified Intake via IDP

AI-powered IDP captures and normalizes EDI, portal, and paper inputs into a single claims queue with upfront member and provider validation.

Digital Mailroom Solutions

Digital Mailroom (DMR) Solutions

Digitize, route, and securely manage physical mail through configurable workflows accessible via a web-based portal.

End-to-End Adjudication

End-to-End Adjudication

Execute rules-driven determinations across eligibility, pricing, and contracts with scalable auto-adjudication and SLA-governed exception handling.

Comprehensive Plan and Specialty Support

Comprehensive Plan & Specialty Support

Broad coverage across Medicare, Medicaid, Commercial, and specialized lines, including Dental, Vision, and Pharmacy (DME) for PPO, HMO, and POS models.

Rework Adjustment and Correspondence

Rework, Adjustment & Correspondence

Streamlined management of claim corrections, appeals, and eligibility failures through structured workflows that prevent incorrect billing and ensure compliance.

Payment Integrity and Compliance

Payment Integrity & Compliance

Protect financial accuracy with governed rule frameworks, audit trails, and integrated fraud monitoring aligned with CMS and HIPAA to ensure 99.8% dollar accuracy.

Our Proprietary Technology

Intelligent Document Processing (IDP): An AI platform using ML, OCR, and NLP to automate the capture, classification, and validation of unstructured data into traceable, structured assets.

Digital Mailroom (DMR): A SaaS solution that digitizes physical mail into secure, searchable assets with automated routing, full tracking, and a secure web-based portal.

Automated Claims Solution (ACS): A proprietary AI/ML engine that applies configurable business, clinical, and coding edits to drive up to 21% straight-through automation across the lifecycle.

XBP Analytics & Insights: Real-time dashboards and predictive tools that track first-pass yield, denial drivers, and cycle times to support continuous rule optimization.

BENEFITS

Optimize your claims ecosystem with a powerful combination of AI-driven efficiency and rigorous financial integrity. Our approach helps payers reduce waste, accelerate processing, strengthen compliance, and deliver better experiences for both providers and members—while scaling confidently for enterprise-level transaction volumes.

  • Achieve 99.8% accuracy and 99% payment precision
  • Eliminate $1B+ in annual waste and contract leakage
  • Increase first-pass yield through automated rule enforcement
  • Shorten cycle times with SLA-driven automated workflows
  • Improve provider satisfaction through faster, transparent payments
  • Ensure regulatory compliance with full audit trails and CMS/HIPAA alignment
  • Enhance member experience with accurate, transparent determinations
  • Scale reliably with cloud-ready infrastructure built for high-volume transactions
  • Sustain performance excellence with consistent >50 NPS across engagements

$1.7 Trillion+

Billed Claims Value Handled Annually

$215mn

Claims Date Captured/Processed Annually

17Mn+

Claims Adjudicated Annually

$30Bn+

In Claims Value Reviewed and Adjudicated

Up to 21%

Claims Automated

>99.80%

Dollar Accuracy

>99%

Processing & Check Payment Accuracy

BENEFITS

Optimize your claims ecosystem with a powerful combination of AI-driven efficiency and rigorous financial integrity. Our approach helps payers reduce waste, accelerate processing, strengthen compliance, and deliver better experiences for both providers and members—while scaling confidently for enterprise-level transaction volumes.

  • Achieve 99.8% accuracy and 99% payment precision
  • Eliminate $1B+ in annual waste and contract leakage
  • Increase first-pass yield through automated rule enforcement
  • Shorten cycle times with SLA-driven automated workflows
  • Improve provider satisfaction through faster, transparent payments
  • Ensure regulatory compliance with full audit trails and CMS/HIPAA alignment
  • Enhance member experience with accurate, transparent determinations
  • Scale reliably with cloud-ready infrastructure built for high-volume transactions
  • Sustain performance excellence with consistent >50 NPS across engagements
$1.7 Trillion+
Billed Claims Value Handled Annually
$215mn
Claims Data Captured/Processed Annually
17Mn+
Claims Adjudicated Annually
Up to 21%
Claims Automated
>99.80%
Dollar Accuracy
>99%
Processing & Check Payment Accuracy
$30Bn+
In Claims Value Reviewed and Adjudicated

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