• 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

• 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.

• 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.

• 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

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

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

• 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

• 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

• 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.

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• Research Claim edits-front end rejections

• Research Clearinghouse rejections, Payer rejections

• Denials- ERA, Paper EOB, Payer websites

• Research top 10 denial reasons

• View Financial agreements and demographics

• Research denial reason codes

• Extra front-end screening for eligibility denials

• Patient involvement

• Research Policy and coverage changes

• Fee schedule updates

• 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

• 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 on Understanding eligibility data

• Save time on data correction

• Save time on claims resubmission

• Save time on searching transactions.

• Data correction notifications

• File delay notification

• Validation Error notification

• Threshold notification (Rejection, etc)