Kofax Claims Agility

Kofax Claims Agility was purpose-built to extract all data present on medical forms, and greatly improve the efficiency of your staff.
How Kofax Claims Agility Works
Kofax Claims Agility runs on the Kofax TotalAgility® platform. It can be ordered directly or added to any existing Kofax TotalAgility platform to support automated processing of standard CMS 1500 and UB-04 claims forms. Document Classification Kofax Claims Agility automatically detects and classifies professional (CMS-1500) and institutional (UB-04) claims, associates and tracks supporting documents with each claim to form a “claim case file”, and trains the system to identify and classify other claim types. Digitizing these documents enables authorized individuals to quickly access each claim case file to support inquiries, corrections, and follow-ups internally and with subscribers and providers.
Data Extraction
Kofax Claims Agility uses a variety of image registration techniques, OCR engines and data locators to automatically read and extract data from up to 400 fields on the CMS 1500 and UB-04 forms. Data extracted is then automatically validated against a comprehensive rule set and marked for review within the Kofax Claims Agility user interface.
Data Extraction
Kofax Claims Agility applies preconfigured rules to extracted data that implement and enforce the NUBC (institutional) and NUCC (professional) specifications, and also insurer-specific rules that have been implemented, and automatically identifies and provides visibility to all fields that violate any of these rules. Claims with low extraction confidence errors and those that fail the comprehensive rule set are presented to validation workers in an intuitive interface. Automating the extraction and validation of claims empowers organizations to greatly increase processing speeds, identify exceptions faster, and improve the accuracy of data before it is transferred to downstream processes.
Data Export/Interchange
Claims that pass validations or corrections are automatically converted into EDI and routed to the next processing step. The Kofax Claims Agility EDI Export Connector generates ANSI X12 837I/P v5010 files, enabling the normalization of document-driven claims processes.

Benefits of Kofax Claims Agility
Remove Paper, Improve Access and Security
Halt the flow of paper in medical claims to save paper, print, physical storage and people costs. Make crisp, clear claims images available to every authorized individual, preserving the value of “seeing the claim”, while reducing unauthorized access to PHI.
Accelerated Path to More Efficient Operations
With hundreds of engineering hours invested to research, design and build Claims Agility, including a comprehensive rule set and all current medical code sets, organizations can quickly implement a highly efficient medical claims processing solution.
Reduced Data Entry, Increased Productivity and Data Accuracy
Smart claims data capture and validation against medical code sets, NUBC & NUCC rules, insurer-specific rules, and master subscriber and provider data radically reduces errors, and enables fewer people to handle more claims.
Reduce or Eliminate Inaccurate Payments
You can’t control the rising cost of health care, but you can take control of the accuracy of your claims pre-adjudication process through more rigorous and automated data extraction processes.
Stay Productive as Regulations Change
Stay productive and current with changing regulations—before they impact your operations—by implementing a scalable solution that is supported by the multichannel capture market leader, and the leading innovator of Smart Process Applications.
Extend Claims Processing to the Point of Origination™
The Kofax platform offers game-changing options, including the ability to push the start point for claims processing out to the point where it begins, at the care provider’s location. Support for remote web and mobile capture enables submitters to start the process at the Point of Origination, gaining greater visibility into the process and enabling faster initiation of the claims process.
Gain Meaningful Insights with Business Analytics
Dashboards can tell the real story of how a business is performing in an intuitive and insightful way. Gain a clearer understanding of the best options for operational improvement for the complex claims process through the use of intuitive and detailed business analytics.
Ease of Use and Change
Browser-independent user interfaces simplify implementation and engage workers productively. Built-in visual design of workflows, business controls, user screens, etc. enables rapid process improvement.

Features of Kofax Claims Agility


  • Preconfigured Kofax transformation project files and documentation
  • Preconfigured support for the UB-04 (institutional, black and red dropout) and CMS 1500 (professional, black and red dropout) claim forms
  • Preconfigured and comprehensive rule set that validates all extracted data per the NUBC and NUCC specifications, and the ANSI X12 specification
  • Contains the 2015 ICD-9 and ICD-10 code databases (CM, PCS), CPT codes, HCPCS level-2 codes, and HIPPS codes
  • All medical code sets kept current
  • User interface and workflow to review, correct or move claims with errors into work queues for review
  • Integrates with any system of engagement (e.g. MFP, email, fax) and any system of record (e.g., member and provider data stores, claims systems and other legacy systems and data)
  • EDI Export Connector that complies with the current 837I/P v5010 EDI Errata and Addenda
  • Documentation for configuring and customizing the solution, and documentation defining the mapping of CMS-1500 & UB-04 data elements to the 837I/P v5010 EDI files 
 Contact us for more information regarding Kofax Claims Agility.

Latourrette Consulting is a Certified Kofax Partner in Portugal/USA/Brasil/Colombia/España/Nederland/Chile.