Complexedi – In analyzing the entire long term testing landscape there is a critical component of testing that must be implemented throughout the healthcare revenue lifecycle to ensure higher claim accuracy and auto-adjudication of claims. Showing continued thought leadership in testing, Qualedix QA has created a new testing service for analyzing healthcare policy data called Complexedi.

To lower healthcare administrative costs, we empower our clients with the ability to test the implementation of their established policies across their trading partner network. Policies drive healthcare and reimbursement decision management. The complex process of creating realistic healthcare policy EDI test data and the effect of new diagnosis and procedure codes will save our clients millions of dollars in lost revenue due to incorrectly paid or rejected claims and massive manual effort that ensues post claim adjudication. The industry has a choice… either raise prices to combat inefficiencies or utilize Qualedix QA advanced testing to lower operational costs.

Healthcare is driven by policies, benefits and contracts and Complexedi delivers the functionality necessary to bring testing into the future through a powerful rules engine and utilzing our extensie test databases. By analyzing and validating benefit programs and contracts we model our test data to directly reflect employer benefit programs, provider contracts, underwriting and policy programs. The Complexedi data is customized to test all stakeholder rules and programs to ensure that proper payments, enrollements and remittances work as designed. Complexedi takes the industry from measuring auto-adjudication rates to measuring claim accuracy rates and beyond.

As with all of our highly advanced managed services, Complexedi just continues to further our vision of breaking the mold of lackluster tools available today and pushing healthcare into the 21st century by employing industry best practices, proven software testing principles and delivering testing thought leadership. Healthcare cannot keep going down the path of just doing what it did yesterday, it needs new apporaches, new methods that deliver both acceleration and cost containment in order to deliver true value. Vendors that just sell tools are interested in license fees... Qualedix, by delivering managed services are highly vested in our client success by being directly accountable for results.