
Kaiser Permanente implements HiPaaS to improve remittance reconciliation for all non Kaiser claims payments across its 5 regions.

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Improve A/R accuracy & Improve net revenue of the practice
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Improve remittance reconciliation
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Reconcile Claims with Payments including 835 ERA and Treasury files.
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Al Driven and rule based EFT, ERA and Claims Invoice Match
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Reduce denial rate by getting view of rejected or unpaid line items
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Research Payer rejections and denial reasons
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Track secondary submissions
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Transfer the balance to the patient account
Improve Payment
Accuracy and Timeliness
ELECTRONIC REMITTANCE ADVISORY (ERA) POSTING
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Validate claims submission data via loading outbound 837 files
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Reconcile Claims with Payments including 835 ERA and Bank Treasury files.
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Load 835 files and reconcile with outgoing 837 files
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Load Treasury files and compare with 835 files
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Create missing ERA entries and bank entries
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Split ERAs if needed for feeding data back into Epic or EHR instances
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Al Driven and rule based EFT, ERA and Claims Invoice Match
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Reconciliation to claims data to the service line level
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Work queues for manual reconciliation and data correction.
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Post each line item to the respective patient accounts
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Resolve missing EOBs, adjustments, write-offs, and balance transfers.
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Accept online payments in different data formats including data positioned, csv and excel.
RESOLVE WORK QUEUES
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Report and reroute denied claims including manual workqueues for working denials
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Rework and re-submission to payers in a timely manner.
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Check the secondary payer information
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Transferring the balance to the patient account
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Making adjustments/ write-offs as per defined policies
TRACKING AND RESUBMISSION
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Regular checks of the latest claim status including daily and on demand reports
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Realtime Claims status check
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Track claims to payment
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Secondary Insurance submission
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Resubmission for errors
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Real time A/R view
DENIAL POSTING & RESEARCH
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Research Payer rejections and denial reasons
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Report and reroute denied claims including manual workqueues for working denials
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Rework and re-submission to payers in a timely manner.
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Check the secondary payer information
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Transferring the balance to the patient account
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Making adjustments/ write-offs as per defined policies
POSTING PATIENT RESPONSIBILITY PAYMENT
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Integrate with Patient Portal for collecting patient portion.
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Post to collection Agencies
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Resolve any credit balances
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Integrate to Payment Gateway to collect patient portion.
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Integrate to generate notification and reports to send to collection agencies
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Making adjustments/ write-offs as per defined policies