Kofax Claims Agility SPA

Continuing with breakout sessions at Kofax Transform is a presentation on the Claims Agility smart process application that Kofax is creating for US healthcare claims processing, based on the KTA platform. They have built in a lot of the forms and rules for compliance with US healthcare regulations; I suspect that this means that the SPA would not be of much value for non-US organizations.

Claims Agility is still in development, but we were able to get an early look at a demo. The capture workflow is pretty simple: scan, classify and extract data fields from a form, then pass it on to a claims worker for their activities, presenting both the scanned document and the data fields. This is a pretty standard scanned document workflow application, but has the advantage of having a lot of knowledge of the US healthcare forms, data validation, rules and processes built in so that little setup and system training would be required for the standard forms and workflows. Incomplete or incorrect forms can be held, allowing the validated forms in the same batch to be completed. The final step in the predefined workflow performs the EDI transactions.

They will do updates for some components of the system, such as the CMS codes that drive the validation; they haven’t finalized the hot update capabilities, and it’s not clear that they will be able to do much more than update code tables.

We looked at the customizability of the processes and rules: customers can modify the standard processes using the graphical process designer, including building their own processes. Since the out of the box process is really simple — four steps — there’s no real issue of upgradability of the process at this point, but it’s likely that any processes provided should be considered templates rather than productized frameworks. Configuration for data extraction and validation is provided as part of the core package, but again, the customer can override the defaults. I was going to ask the question about the separation of base product from customizations with respect to product upgrades but a customer in the audience beat me to it; there are separate areas for custom versus core code, as well as versioning, so it appears that they have thought through some of this but it will be interesting to see how this plays out after the product is being used at customer sites through a couple of upgrade cycles.

There will be an initial release in June or July this year, and Kofax is looking for early adopters now; full release will be near the year end. Claims Agility is the fifth SPA that Kofax is offering on the KTA platform, and they’re learning more about how to do these right with each implementation, plus how to integrate the new technologies such as e-signature.

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