Services Impactful, Innovative, and Insightful

Paper EOB Conversion

• Hybrid tool that blends technology and skilled manual intervention to convert different formats of paper EOBs to ANSI 835 output files.
• Rule-based customization to accommodate varied payer and provider business rules.
• Flexibility to customize output files based on client requirements.
• Highly trained staff proficient in ANSI denial codes and remark codes used by different payers.
• Sophisticated technology solution enables staff to work with a high degree of accuracy and efficiency.

Electronic Remittance Advisory (ERA)

• ERAs contain high volume of payment transaction that require the data to be handled efficiently.
• Ensures methodical file loading, exception resolution and corrections by utilizing the functionalities in the revenue cycle system.
• Orderly handling of complex ERA batches

Patient Payment

• Extensive experience in processing payments received from patients via multiple sources like POS cash collections, checks, and credit cards (patient portals)
• Ensure that Patient Pay is accurately accounted for, so claims are closed properly and to avoid any inflated AR.
• Skilled payment processing professionals account for patient payments, make informed decisions on transferring any pending balances to secondary insurers, and resolve any credit balances.

Correspondence

• Blend of experienced claims professionals and sophisticated technology helps to remove complexity, cost, and scope of managing claim denials.
• Expert staff conversant with ANSI denial codes and remark codes used by different payers.
• Ability to interpret denials and categorize them as per client requirements.
• Ability to post denials into the customer’s practice management system.
• Tool has the provision to account for actions such as billing the secondary payer, transferring the balance to the patient account.
• Ability to make adjustments/write-offs as per denied policies and routing the denied claims to appropriate work queues.

Manual Payment Processing and Posting

• We provide seasoned claims management professionals to process paper claims in your tool. They ensure payment information from scanned images of Explanation of Benefit (EOB) documents is captured and each line item is posted to the respective patient accounts.
• Our objective is to ensure these claims are complete, accurate, and filed on time for maximum reimbursement.
• Our experts are always up to date on changing payer processing rules, edits, and ANSI requirements.
• By developing practice and physician-specific business rules along with our team, you will be able to ensure accurate payments, adjustments, write-offs, and balance transfers.

Research & Retrieval

• Easily research & view claims, remittances, and payments in a unified portal through encounter, lockbox, and payment centric screens
• Ability to search, view & print: Human Readable ACH, 837, 835, Patient Pay Documents, Checks, EOBs, Correspondence, and Secondary Claims linked to the original encounter.
• All data automatically grouped by patient encounter.
• Reduce research time.
• Easier corrections and faster resubmissions

Business Intelligence

• Offering powerful, flexible and affordable business intelligence to easily analyze trends in billing, collections and denials.
• All of the data is parsed and translated into a reporting database, with data relationships being predefined and pre-calculated.
• The result is a powerful yet easy-to-use analytics framework to discern financial performance trends.
• The system allows drill-down to various levels of detail – if required, down to the individual claim level
• This permits unprecedented ways to understand the “root cause” of collections issues and to focus energy on high-impact remedial plans.
• Reduce denials & resolve recurring problems.
• Ability to rapidly identify process improvement opportunities.
• Speed denial resolution times

Remittance/Payment Reconciliation

• Payment triggered auto release of 835s/ERAs.
• Technology assisted manual release of 835s/ERAs.
• Ability to easily identify all unmatched remittances/payments.
• Identification of duplicate paper EOBs & ERAs.
• Automated payment (check & ACH) reconciliation with remittance advices. (ERA/EOB) allowing for the release of 835s that have been paid.
• There are frequent “arrival time” differences between when a provider receives EOB, check deposits, ERAs and ACH payments.
• A unique matching algorithm that will hold an EOB or ERA from posting until the matching payment is received.
• This can reduce the complexity and time required by a provider treasury or finance staff to reconcile bank balances with A/R.

Throughput

Efficiency

Scale

Enrollment

Demographic Entry

Data Transcription / Translation

Scheduling appointments with reminders

Travel arrangements (hotel, flight, conference registration)

Creating presentations (content given)

Tracking expenses

Updating resumes

Process Refinement

Workflow Optimization

Product/Software Testing