CLAIMS SUBMISSION 

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

• Convert claims data to EDI

• Validate and correct the claims before submission

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

• Manual corrections of claims data

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

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

• 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

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

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

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• Research Clearinghouse rejections, Payer rejections

• Research denial reasons

• Review Eligibility

• Review Prior Authorization

• View Financial agreements and demographics

• Research denial reason codes

• Extra front-end screening for eligibility denials

• 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

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