Claims Administration and Adjudication

Use configurable workflows to automate claims administration and adjudication workflows in your organization.

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Automate Claims with Confidence

Streamline your entire claims lifecycle: from intake to payment with AI-powered automation. LightSpun ensures fast, accurate, and rules-driven adjudication, reducing costs and eliminating manual errors. Scale operations effortlessly while improving provider and member satisfaction.

90%
of claims are auto-adjudicated
50%
Reduction in IT administration costs

Flexible Eligibility Management

Intake, resolve and standardize member eligibility files from multiple data sources (EDI 834, CSVs etc).

Plan

Configuration

Reduce the complexity of configuring, loading and managing bundled plans for commercial, individual and government plans.

Automate Claims with
EDI Standards

Integrate with clearinghouses using EDI standards (e.g. 837, 834, 270/271, 276/277) and automate mail rooms/fax/email claims using AI to auto adjudicate claims

Reporting 

& Insights

Real-time insights that go beyond predictive to prescriptive for operating and financial metrics such as claims payout, loss ratios, utilization reviews, provider metrics and membership trends.

Get claims processed faster —   with AI doing the heavy lifting

Provider Management

Intake and manage provider directory, multiple networks and fees for claim adjudication

Billing & Payment

Create, configure and administer payment, billing, premiums, receivables and payables for all groups and plans

Compliance & Audits

Manage and monitor state and federal compliance regulations with a SOC-2 Type II certified platform

Trusted by clients

“LightSpun was able to seamlessly integrate their platform with our existing systems and was able to deploy the entire platform within months due to the teams in-depth domain knowledge in technology, AI and dental”
Insurance Payer
VP, Information Technology
“Using LightSpun’s Claim Intake Automation module, we will reduce manual intervention on paper claims by 95%.”
Insurance Payor
President
“Our claims administration cost was reduced by 50% thanks to LightSpun’s Claims Administration & Adjudication Platform.”
Insurance Payor
CEO
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Unlock your organization's full potential

Partner with Lightspun to make transformational changes to your organization. Our unified platform helps our customers achieve lasting results through intelligent automation, reduced processing time, and enhanced provider network management.

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