The diagram represents the “80/20” implementation model. The items included in blue represent 80% of the core structure and functionality of the Claims Engine system. The items in gray represent the remaining 20% of the system, conﬁgured speciﬁcally around the IAIABC EDI standard as well as, adjudication, workﬂows, business rules, reviews, ﬁnancials, and reports needed for your organization.
Business Logic, Financial, Forms, Help, User, Submission and Work Queue
Integration + Performance & Metrics Analytics
Documents of Records, Reporting, & File Uploads
This blend of core functions and precise configuration is a model that allows for high-level flexibility
in managing claims for your organization, while leveraging a proven secure platform. Claims Engine
reduces the dependency on multiple systems to help organizations manage everyday business
activities as efficiently as possible.