Claims Adjudication System Insight Engine (CASIE)
Busita
+30
Years of
experience
4.9
+2.3K Reviews
Simplify Claims. Maximize Revenue. Gain Control.
ESI Healthcare’s Claims Adjudication System Insight Engine (CASIE) simplifies and streamlines the complex world of healthcare claims adjudication. Designed specifically for hospitals, teaching facilities, provider networks, and third-party administrators, CASIE automates the evaluation and reconciliation of claims—ensuring accuracy, transparency, and full compliance with regulatory requirements. With customizable rules, flexible fee schedule integration, and robust reporting, CASIE empowers organizations to efficiently manage financial processes, reduce administrative burden, and optimize reimbursement outcomes.
esi healthcare business solutions
+200
Expert Employees
+4500
Completed Projects
+3800
Happy Customers
+98.9%
Customer satisfaction
Uncovered $2.4M
A public health system uncovered unclaimed indigent care reimbursements worth $2.4 million using the Claims Adjudication System Insight Engine.
Reduced Workdload 75%
A provider network TPA reduced adjudication workload by 75%, while increasing accuracy and provider trust.
Who It's Built For
The Claims Adjudication System Insight Engine is designed for healthcare organizations that operate outside traditional payer pipelines:
-
Academic Health Systems (i.e. teaching hospitals that partner with medical schools) needing accurate, contract-based reimbursement
-
Public Safety Net Hospitals These hospitals receive payments through state-administered programs designed to offset the costs of providing care to uninsured and underinsured patients who cannot pay for their services
-
Non-Traditional Payer Organizations Covers TPAs, provider networks, and self-funded groups with custom rules
-
Direct-Pay Claims Entities handling direct-pay or contracted claims
-
Hospital finance teams seeking transparency in complex adjudication workflows
-
Provider Payment Operations Teams within a health system
Content Marketing
Social Engagement
Identity & Branding
Product Design
Challenges Solved
-
Manual claims reconciliation is time-consuming and error-prone
Most hospitals rely on spreadsheets and manual calculations to reconcile claims that fall outside traditional insurance pipelines. without automation, it’s difficult to accurately quantify the value of services delivered – especially for uninsured or underfunded patients -
Reimbursement errors go undetected
Without clear alignment to fee schedules, RVUs, or custom business rules, organizations risk overpaying, underbilling, or misreporting — often without realizing it. -
Lack of defensible, audit-ready reporting
Hospital executives need clear documentation to justify budgets for indigent care, residency programs, or government funding — but standard systems can’t provide it. -
Complex reimbursement models don’t fit legacy systems
Traditional claims platforms aren’t built to handle non-standard business logic – like bundled services, alternate rate multipliers, or special program carveouts. -
Internal teams are stretched thin
Finance and operations teams spend excessive time verifying claims manually. Without automation and rule-based logic, scaling reimbursement workflows becomes unsustainable.
Content Marketing
Social Engagement
Identity & Branding
Product Design
What Makes the Claims Adjudication System Insight Engine Work
-
Custom Claims Rules
Apply your actual business rules: CMS-based, private negotiated, or custom logic per payer. -
Flexible Fee Schedule Integration
Supports Medicare rates, multiple-of-Medicare contracts, fixed-price models, and hybrid structures. -
Transparent RVU-Based Logic
Uses Relative Value Units (RVUs) to standardize and justify all reimbursements across departments and services. -
Adjudication on Your Terms
Run the engine daily, weekly, or monthly. Review and validate before closing out batches. -
Zero-Code Configuration
We implement your logic — no scripting or in-house tech team needed. -
Audit-Ready Reports
Export line-level logic for internal use or external audits. Supports EOBs, 835s, and custom dashboards.
Content Marketing
Social Engagement
Identity & Branding
Product Design
Report Outputs That Drive Confidence
The Claims Adjudication System Insight Engine includes powerful reporting to help clients explain where every dollar goes:
-
Executive Summary Reports
See accepted and denied claim totals, RVU metrics, and financial performance by funding type. -
Department-Level Reports
Breakdowns of claims by department or division (e.g., surgery, trauma, cardiology). -
Anesthesia Base-Time Reports
Adjudicate time-based services with custom conversion factors.
Content Marketing
Social Engagement
Identity & Branding
Product Design
Why Healthcare Leaders Choose CASIE
-
Built specifically for hospital systems and provider networks
Not generic claims processors, uninsured care reconciliation -
Full control over reimbursement logic, without complexity
Use your own RVUs, fee schedules, and business rules with easy-to-configure automation. -
Transparent, line-by-line payment explanations
Get defensible documentation that shows exactly how every claim was evaluated and paid. -
Unlocks real insights for CFOs, compliance teams, and auditors
Turn claims data into actionable reporting for audits, funding applications, or internal reviews. -
Makes budgeting for indigent care or residency programs data-driven and defensible
No more guesswork — understand actual costs and service value across non-traditional payment models.
-
Executive Summary Reports
See accepted and denied claim totals, RVU metrics, and financial performance by funding type. -
Department-Level Reports
Breakdowns of claims by department or division (e.g., surgery, trauma, cardiology). -
Anesthesia Base-Time Reports
Adjudicate time-based services with custom conversion factors.
Content Marketing
Social Engagement
Identity & Branding
Product Design