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HIREV

Complete Revenue Cycle Management Platform. Easily manage Eligibility, Prior Authorization, Claims Submission, Automation of Payment Posting, ERA and Remittance. 

HIPAAS IS MANAGING REMITTANCE POSTING FOR THE LARGEST MANAGED CARE ORGANIZATION WITH

 12M+ MEMBERS

FEATURES

ELIGIBILITY

  • Detailed eligibility for various service codes

  • Complete Medicare and Medicaid eligibility data ( Part A, D )

  • Check eligibility for various services

  • Check extended benefits

  • Check Home health eligibility, Nursing home eligibility, Hospice and others

  • Check Therapy and mental health eligibility

  • Check Chiropractor eligibility

  • Check eligibility in realtime in secs 

  • Batch all eligibility request and submit offline

CLAIMS SUBMISSION & CODING

  • Integrate to EHR/Practice Management Software and submit via 837 I, P, D EDI

  • Automatically convert visits into claims data

  • Validate and correct the claims before submission

  • Smart Claims creation and corrections, save time on data entry and corrections

  • Manual corrections of claims data

  • Smart correction of claims data

  • Data entry screens for CMS 1500s and UB-04s

  • Submit claims electronically via direct data entry (DDE) screens.

  • Al Driven EFT. ERA and Claims Invoice Match.

  • Reconciliation to claims data.

  • Queue Line item denials and resubmit

  • Create work queues for line items splits, code changes, payment data changes.

  • Match bank payments

  • Create Patient responsibility bills and accept online payments.

MANUAL EOB PAYMENT POSTING

  • Get Payment information from scanned images of Explanation of Benefit (EOB) documents

  • Post each line item to the respective patient accounts.

  • Resolve missing EOB,  adjustments, write-offs, and balance transfers.

  • OCR Reading

  • Data Entry screen

  • AI driven rules to match Claims

  • Resolve missing EOB,  adjustments, write-offs, and balance transfers.

POSTING PATIENT RESPONSIBILITY PAYMENT

  • POS cash collections, checks, and credit cards (patient portals).

  • Post from collection Agencies

  • Resolve any credit balances

  • Write-offs and adjustments

  • Integrate to Payment Gateway to collect patient portion.

  • Integration to generate notification and reports to send to collection agencies

  • Write-offs and adjustments rules

REAL TIME AND BATCH REQUESTS

  • Check eligibility, Prior Auth, Claims Status in realtime in secs 

  • Batch all eligibility, Prior Auth, Claims  request and submit offline

Resolve Work Queues

  • Report and reroute denied claims

  • Rework and re-submission to payers in a timely manner.

  • Check the secondary payer information

  • Transferring the balance to the patient account

  • Routing the denied claims to appropriate work queues.

  • Making adjustments/ write-offs as per defined policies

PRIOR AUTHORIZATION

  • Detailed prior authorization data creation

  • Import data from EHR and EMR

  • Validate Prior Auth before submission

  • Manual creation of Prior Auth request

  • Add supporting data and attachments

  • EDI integration to payers

  • Complete Medicare and Medicaid prior auth with covered vs not covered

  • Check Prior auth for various services

  • Prior auth templates

  • Request for Home health, Nursing home, Hospice and others

  • Check Therapy, Chiropractor and mental health prior auth

  • Track responses from Payer

  • Integrate to appointments and patient outreach

  • Research denials  - smart analysis tool

  • Check submission issues

ELECTRONIC REMITTANCE ADVISORY (ERA) POSTING

  • Reconcile Claims Payments, 835 ERA and Treasury files.

  • Manual corrections

  • Create missing ERA entries and bank entries

  • Al Driven EFT. ERA and Claims Invoice Match.

  • Reconciliation to claims data.

  • Queue Line item denials and resubmit

  • Create work queues for line items splits, code changes, payment data changes.

  • Match bank payments

  • Create Patient responsibility bills and accept online payments.

DENIAL POSTING & RESEARCH

  • Report and reroute denied claims

  • Rework and re-submission to payers in a timely manner.

  • Check the secondary payer information

  • Transferring the balance to the patient account

  • Routing the denied claims to appropriate work queues.

  • Making adjustments/ write-offs as per defined policies

TRACKING AND RESUBMISSION

  • Check the latest status of claims

  • Realtime Claims status check

  • Track claims to payment

  • Daily and on demand reports for claims status

  • Secondary Insurance submission

  • Resubmission for errors

  • Real time A/R view

SAVE TIME

  • Save time on Understanding eligibility data

  • Save time on data correction

  • Save time on claims resubmission

  • Save time on searching transactions.

Notifications

  • Data correction notifications

  • File delay notification

  • Validation Error notification

  • Threshold notification (Rejection, etc)

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GET STARTED

Invest your time where it's needed. Set it up once and auto-scale

HIPAAS supports AWS Cloud, Azure or GCP or On-Prem for Enterprise customers. 

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