VestaCare's solutions for PPOs
Advanced claims automation and control solutions to streamline operations and maximize efficiency.
Claims Automation & Control Solutions
VestaCare's advanced claims automation platform is designed to maximize straight-through processing and reduce manual adjudication effort for Payers, TPAs, and PPOs. It complements — not replaces — core claims systems by automating the most complex, repetitive, and labor-intensive steps in the claims lifecycle.
Using a combination of robotic system interfaces, rules-based decisioning, and workflow orchestration, our solution improves processing speed, accuracy, and operational efficiency while maintaining full visibility and control over every claim.
How It Works
VestaCAC automates claims intake, validation, eligibility verification, duplicate detection, PPO routing, and claim loading by interfacing directly with a client's adjudication system. Through its robotic automation layer — Automated Smart Examiner™ (ASE) — VestaCAC replicates human interaction with claims platforms, codifying decision logic that would otherwise require manual handling.
The result is fewer claims routed to staff, faster turnaround times, and higher utilization of automation across the claims workflow.
Core Capabilities
Claims Intake & Capture
Support for both EDI and paper claims with automated scanning, indexing, and conversion to standardized formats.
Eligibility Verification
Automated eligibility verification using layered matching logic and real-time system interaction via ASE.
PPO Routing & Repricing
Automated routing to appropriate PPOs or repricing partners based on configurable business rules.
Workflow Management
End-to-end visibility with real-time tracking, exception queues, and automated claim loading.
Ready to Transform Your Claims Processing?
Join healthcare organizations that have automated their claims submission and reduced denials with VestaCAC.