A pended claim is where a problem becomes visible. The cause may lie upstream in benefit interpretation, configuration, code updates or testing. Automating the next task alone may leave that cause unresolved.
The Connected Claims Operating Model examines how payers can bring domain intelligence, enterprise workflows and accountable human execution together. Co-authored by leaders from Simplify Alpha™ and ServiceNow®, the paper outlines complementary roles for ServiceNow®, Simplify Alpha™ and Simplify Healthcare's Claims1™ platform, with the existing claims core remaining the system of record.
Identify upstream gaps that can contribute to downstream exceptions, denials and rework.
Understand how claims-domain capabilities and enterprise orchestration contribute to a connected operating model.
Define human oversight, decision rights and evidence requirements for AI-assisted claims work.
Assess payer readiness and use a four-week Discovery Sprint to scope a priority claims journey.
Health plan leaders in claims operations, transformation, technology and payment integrity.
Download the Whitepaper
Get your copy of The Connected Claims Operating Model, co-authored by Simplify Alpha™ and ServiceNow®.
