Exception Management is to claims processing what patient triage is to the emergency department at a hospital. In much the same way that patient triage uses established protocols to handle specific situations, the Exception Management protocols within AdminisTEP (the technology platform powering the Hawai’i Xchange) applies payor-defined logic to validate, segment and route transactions in the most efficient and cost-effective manner.

Clean claims are sent to the payor host system for processing, claims with specific types of errors are sent back to providers for edits, while other error types are placed in queue for analysis. The result is higher first-pass rates, as well as a streamlined and cost-effective process to handle claim errors.