HealthAxis Determinants®


How will the Determinants® System help my organization?

The HealthAxis Determinants® System enables your organization to take on new business quickly and efficiently by:

  • Reducing staff burden with automated workflows
  • Reducing manual processing
  • Enabling users to handle a large volume of claims

How will Determinants® increase customer satisfaction?

The HealthAxis Determinants® System enables partners to reduce unnecessary costs and increase customer satisfaction by:

  • Reducing customer service calls from patients
  • Reducing turnaround time of responding to members
  • Reducing user error with automated workflows

What are the Determinants® Usage/Categories?

  • Authorization – used to determine which authorization applies to the claim/line
  • Benefits – used to determine which benefit applies to the line item
  • Contract – used to determine which contract can be used for pricing
  • DOFR – used to determine risk-type
  • Fee Schedule – used to determine if a fee schedule item applies to the line item
  • Membership – used to determine how to handle TRC response codes
  • Pre-Existing – used to determine whether a condition is pre-existing
  • Rider – used to determine which rider may apply
  • Sensitive Services – used to determine which services to consider sensitive
  • Utilization Worklist – used to determine user access/priority within the UM queue
  • Provider Worklist – used to determine user access/priority within the PR queue
  • Claim Worklist – used to determine user access/priority within the claims queue
  • Authorization Worklist – used to determine user access/priority within the authorization queue
HealthAxis Group Determinants


As the healthcare landscape becomes more consumer-centric, healthcare organizations must rely on innovative technology in order to remain competitive. The HealthAxis Determinants® system provides partners with improved benefit plan implementations, operational efficiencies for lower operating costs and adaptability to a rapidly evolving landscape.
A Determinant® is an end-user configurable decision point; and is used in some form or another in every module of the HealthAxis system.
In a claim line item evaluation scenario, Determinants® can be used to do the following:
  • Determine which benefit (if any) applies.
  • Determine whether the line item or the whole claim is a duplicate.
  • Determine which contract will be used for each line item and which fee schedule item it should be priced with.
HealthAxis Determinants
What sets the HealthAxis Determinants® System apart from any other solution on the market is its revolutionary approach to configuration. Our system enables partners to:

Respond to new business opportunities quickly, while reducing costs & improving operational efficiences.

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Quickly implement new benefit plans and offerings.

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Take on new business and automate business lines with the extremely flexible Determinants® rules.

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