EXLMINE™
Payers are seeing claims volumes and system integration needs grow exponentially year upon year, while audit staff struggle to identify and act on potential improper claim payments. EXL’s proprietary workflow application EXLMINE™ is a robust digital business process automation tool designed to help by centralizing all functions needed to manage the entire life cycle of an audit.
EXLMINE™: An end-to-end audit workflow management platform
Claims auditing is a core function of health plan payment integrity operations, but many payment integrity departments lack the ability to track and manage inventory effectively, and others struggle with disparate processes or workflow solutions that require custom builds and integration workarounds into claims platforms.
Our proprietary workflow application, EXLMINE™, is a robust payment integrity system, supporting both pre-payment and post-payment modalities, and is designed to help audit staff to identify, manage, and act on potential improper claims payments. The system improves effectiveness and efficiency by centralizing all functions needed to manage the entire life cycle of an audit from data intake to overpayment recovery to reconciliation and reporting.
EXLMINE™ helps our customers to become more efficient and drive deeper and more meaningful savings.
- Central inventory platform provides auditing system of record to effectively and efficiently identify insights and manage activities
- Customized configurability to your specific program needs to deliver superior performance, maximum savings, reduced operating costs, and increased accuracy
- Sophisticated reporting capabilities, delivering real-time access and transparency into operational processes and activities
Supporting EXL clients’ unique business needs
EXLMINE™ centralizes all claims audit processes on a single platform, delivering an intelligent experience for claim workflows and inventory management. The EXLMINE™ platform is highly configurable, customizable to meet the demand of any data mining or audit program to support our clients’ business needs.
Modular workflow management
EXLMINE™ supports end to end assignment and routing of audits based on user-defined parameters and provides transparency through detailed status and audit findings tracking of all individual audits. Leveraging our broad expertise and installed base, EXLMINE™ includes a number of default workflows that can be used “out-of-the-box” which saves time and effort, requires fewer design decisions, and minimizes custom coding, debugging and documentation
Sophisticated selection module
EXLMINE™ combines robust analytics with rules-based and sophisticated query-based algorithms to identify suspicious claims with likely errors and overpayments – leveraging criteria either client-provided or generated by EXL with client input
Advanced security
HITRUST certified, and HIPAA and ISO 2700-1-compliant to manage regulatory risk
Built-to-scale
EXLMINE™ can easily accommodate increases in volumes, new modalities, and growing auditor teams.
Provider support
EXLMINE™ is integrated with our provider portal, a web application that can be used by a plan’s providers, who receive medical record requests from EXL Health. Providers can upload medical records using this portal, in lieu of submissions via mail or fax.
Delivering $1 billion in savings for a Fortune 500 health plan with EXLMINE™:
EXL Health and our health plan client began our partnership over two decades ago, and since then, have steadily expanded the breadth and depth of our services to include multiple large-scale payment service programs and the EXLMINE™ platform. The client leverages EXLMINE™ to support both pre- and postpay claims modalities, with medical record based clinical audit services including in-patient, outpatient and specialty services. The client currently has over 600 auditors on EXLMINE™, which has been configured and customized to support their workflows, and includes reporting and branding in their own custom correspondence templates.
EXLMINE™ and EXL Health’s payment integrity services have been able to support the client and their claim audit needs through multiple initiatives, resulting in $1 billion in savings.
EXL Health payment integrity
At EXL Health, we believe in a modular approach to payment integrity, allowing our customers access to the right software, analytics, people, and processes to transparently identify and address overpayments, trends, and unique business challenges. Our innovative approach provides payers deeper insights into their payment integrity program through transparent and accessible information, resulting in reduced costs, improved payment operations, and accelerated savings recognition.
EXL Health recognizes the need for digital enablement at every phase of a payment integrity program and uses innovative technologies to select more claims with greater accuracy, capture greater savings volumes, and improve operational productivity.