Best Healthcare Claims Management Software Solutions

Best Healthcare Claims Management Solution

Hospitals & Health Systems Claims Management Solutions

Four-time winner of the Best in KLAS award for Claims Management! Achieve an industry leading clean claim rate of 99.7% first-pass acceptance with payers for fast reimbursement.

99.7% first-pass acceptance with payers

Automated & Analytics-Driven Healthcare Claims Management

Quadax Claims Management is a four-time KLAS award winner, delivering 99.7% first-pass acceptance and faster reimbursement through smart automation, denial prevention, and data-driven workflows. Seamlessly integrating with your billing and EHR systems, our solution accelerates claim processing, boosts accuracy with rules-based validation, and provides actionable insights through advanced analytics.

With ongoing monitoring of payer rules by our expert RCM team, you can optimize staff resources and stay compliant—confident your claims are always aligned with the latest standards.

Xpeditor

Automate Claims Management Workflows

Quadax’s proprietary claims management software automates workflows to quickly route claims to each biller based on the criteria you define, and when necessary, routes claims internally to maintain an accurate audit trail, reducing the need to communicate through an external environment. Integrated workflow automation between Xpeditor™ and EHRs and/or billing applications result in streamlined processes that improve clean claim rates, reduce administrative costs and provide the insight and control to recover expected reimbursement with speed and efficiency.

XpressBiller

Auto Fix and Scrub Claims with Custom Rules & Edits

The path to improving clean claim rates begins with an ounce of prevention. Prevent key issues that derail claims and reduce profits with XpressBiller. Quadax’s powerful rules and edit engine empowers you to automatically detect, assign, correct and minimize errors in real-time before the claim is released to the payer. Now you can gain more control over your revenue cycle and meet the demands of your most difficult payers without involving IT, and at no additional cost.

SafetyNet

Your Shield for Clearinghouse Resilience

Clearinghouse outages can bring your revenue cycle to a standstill. Quadax SafetyNet provides a robust backup solution, ensuring uninterrupted claims processing. Unlike generic backup systems, SafetyNet is pre-configured and deeply integrated with your existing clearinghouse, mirroring your primary system, including all your critical settings. This means your team experiences a seamless transition, with no need for new logins, workflow adjustments, or provider enrollment updates. And, it provides peace of mind, knowing your revenue cycle is secure so you can focus on patient care.

Intelligence by Quadax™

Revenue Cycle Analytics & Reporting

Intelligence by Quadax (iQ) is our all-in-one AI framework built to streamline automation, deliver predictive insights, and optimize performance across the entire revenue cycle. From patient access to denial management, iQ empowers healthcare organizations to minimize friction, accelerate processes, and drive better outcomes.

Edits & Documentation Group (EDG)

Comprehensive Library of Claim Processing Rules & Edits

Sources and related document links are embedded within Claims Management and offer full transparency into Quadax’s rules and edit logic, policies and procedures. This includes: revision history, payer explanations and links to documentation, recent updates and custom comments–allowing clients to leave their own documentation. Our comprehensive, up-to-date library of claim processing rules and edits are updated bi-weekly by our Edits & Documentation Group (EDG). The Quadax EDG team of experts, who are knowledgeable in both billing and ANSI claim requirements, reference nationally recognized sources, including AMA, CPT guidelines, Medicare Physician Fee and more.

Additional Features of Claims Management

Convenient FISS Connectivity

Quickly access FISS to make Medicare claims management easier than ever.

The Quadax Portal is your gateway to a wealth of information, valuable resources and customer support, and now, your staff’s gateway to Medicare’s Fiscal Intermediary Standard System (FISS). DDE Link matches Portal files to each of your named users. Users easily log in right from the familiar Quadax Portal using their own Medicare Online System ID and password to access all of the functions they need. Integration with FISS can be quickly and easily enabled with no extra hardware required.

Electronic Claim Attachments

Support electronic claim attachment submission functionality to help free up staff resources, reduce postage costs and secure revenue faster.

Eliminate the need for mailing paper records and reduce processing time by sending attachments electronically. With Quadax’s claim attachment feature, users can submit claim attachments electronically from Xpeditor™, using a simple point and click method, or send us a 275 and we can automatically match and link it to the respective claim and send automatically, barring no edits on the claim. This reduces errors and time spent sending attachments manually by mail or by fax.

Integrated Coverage Validation (ICV) for Medicare and Medicaid

Reduce Medicare and Medicaid eligibility and registration denials with electronic access portals to alert billing staff of missing or inconsistent details prior to claim submission.

With Integrated Coverage Validation (ICV), our clients have seen up to a 78% reduction in eligibility related denials on Medicare and Medicaid claims. ICV enables Quadax to check HETS (the HIPAA Eligibility Transaction System) in real-time and before a Medicare claim is submitted, and check Medicaid eligibility in real-time with the Medicaid state. Staff can correct preventable errors up-front and submit cleaner claims the first time to avoid payment delays and extra work often required through claim follow-up. Examples include: subscriber verification, active HMO/MCO, Part A/B coverage, and MSP liability.

Advanced Claim Status (ACS)

Increase cost savings by integrating a richer and more complete claim status response into workflows to save staff time and effort and enable further automation.

Advanced Claim Status™ (ACS™) by Quadax is an automated solution giving you actionable claim status information sooner so your staff can work smarter! Using web-bot technology, this direct-to-payer-portal system replaces or supplements standard 276/277 ANSI transactions in order to provide a richer, more actionable data set as soon as one day post-billing. Streamline follow-up staff effort and reduce your cost to collect!

Real-Time Error Resolution in Epic

Epic Claims Processing

Seamlessly integrate claims generated by the Epic Resolute Billing system with all facets of Xpeditor into a single process, applying industry-leading Xpeditor claims management edits and rules for cleaner claims, while retaining workflow and response data in the Epic Resolute system. No need to wait for the next batch, Quadax returns the claim validation and response almost immediately to help you increase efficiency and accelerate reimbursement.

Claims & Reimbursement Support Services

Rely on the Experts

Quadax revenue cycle experts provide routine, on-site visits to assist with event creation and resolution, continued training, reporting needs, best practices and general issue resolution. Quadax provides the perfect blend of sophisticated technology with reliable, expert, personal support.