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Features
- A multimillion rules medical necessity engine that automates medical claims adjudication processes.
- Support multiple global/or/international coding standards, including ICD10, CPT4, HCPCS, CDT and the UAE drug lists.
- Ability to handle sophisticated logic by coupling with patient claims, patient condition, and the physician providing services.
- Designed to be further improved through interaction with other solutions by machine learning and AI.
Validation Rule Engine
Tasees RCM’s Rules Engine is a service provided to healthcare organizations. it is an all-you-need solution that systemizes claims adjudication. This solution supporting multiple coding standards. Its high auto-adjudication rate greatly reduces the claim denials.
The rules engine it employs performs standard checks for coding (CMS), pair checks, maximum daily allowance, age and gender, Approval requirements as well as policy general exclusions. This solution has been developed with payer guidelines in mind, ensuring that resources are allocated on the constant improvement of operations, rather than draining them in delays, denials and dispute settlements.
Benefits
Designed to be further empowered with artificial intelligence and machine learning, allowing for the potential to handle complicated and sophisticated cases.
Continuously enriched and updated based on the volume of claims to detect and analyze data patterns, enabling strategic decision making to control costs, identify incorrect billing, and reduce claim denials.
An intelligent platform housing millions of medical rules and rule edits, capable of assessing claims for plausibility and clinical appropriateness.
The rule engine systematizes claims adjudication to optimize process quality, reduce claims costs, and maximize Revenue.
Flexible, with the ability to be deployed to simplify and automate several processes to redesign a digital claims journey.
Accelerate claim approvals to strengthen cash flow and reduce administrative work, resubmission expenses and repeated tasks.
Reduce operating and medical costs by reducing full-time employees needed for medical adjudication.
Features
- Inpatient, Outpatient, and Pharmacy claim segregation – Claims are routed into separate queues by type, enabling role specific handling and TAT based prioritization.
- Submission, Resubmission, and Reconciliation queues – Each lifecycle stage is managed in a dedicated queue with TAT tracking, improving visibility and follow up accuracy.
- Auto allocation of claims – Claims are assigned automatically based on workload, specialty, and predefined TAT rules, ensuring balanced and timely processing
- Manual allocation of claims – Supervisors can manually reassign claims to specific users or queues when escalations, overrides, or urgent TAT targets apply.
- Pull out of claims from queue – Authorized users can temporarily pull claims from an active queue for review, correction, or escalation without breaking TAT tracking.
- TAT driven status tracking and alerts – The system monitors processing time against set TAT thresholds and triggers alerts for aging, overdue, or high priority claims.
Queue Management System
The Integrated Claims Queue Management System is a centralized platform that streamlines medical claim processing by separating inpatient, outpatient, and pharmacy claims into distinct queues, along with dedicated workflows for submissions, resubmissions, and reconciliation. The system is designed to maintain and monitor turnaround time (TAT) at every stage, ensuring claims move efficiently from submission to payment and reducing delays across the revenue cycle.
Benefits
Reduced claim denials and rework – Structured handling of submissions, resubmissions, and reconciliation minimizes errors and duplicate work within agreed TAT.
Improved operational efficiency – Segregated queues and TAT‑aware workflows reduce bottlenecks and manual interventions, speeding up claim handling.
Maintained and controlled TAT – The system enforces defined processing timelines across all claim types and stages, improving predictability and SLA adherence.
Faster resolution and cash flow – Timely identification of pending or denied claims shortens payment cycles and supports faster revenue realization.
Better workload balancing – Auto‑ and manual allocation ensure fair distribution of claims while respecting TAT targets, preventing overloading of staff.