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The Total Revenue Cycle Management Solution for Physicians

Internet based solution that is secure and easy to use. Working with your existing practice management system we can accept ANSI, NSF or HCFA print image files 

 

Claims Follow Up

  • End lengthy phone calls tracking the status of claims
  • Claims by status – pending, rejected, paid
  • Filter and work claims by subscriber, payer, physician, status, batch, dates or patient
  • View all payer status messages and any edits made to the claim
  • Totally paperless administration (paper reports are always available if needed)
  • Automatically generate letters for timely filing, claim appeal or claim status 

 

Rules Based Claim Management

  • Reduce rejected claims with rule based claim management
  • Powerful and flexible table driven rules
  • Testing rules by payer, provider or practice
  • Response rules for claim status
  • Substitution rules by payer, provider or practice

Product Features

  • Secure Environment:  Uses the industry recognized technology for secure and encrypted information transfer over the internet.
  • Customizable Claim Handling Rules By Practice, Carrier or Provider:  Individual rules can be customized for each practice, specialty, insurance carrier or individual provider.  This is designed to insure mandatory data is provided on each claim, insuring timely and accurate claims submission for fast reimbursement.
  • Accepts Insurance Claim Print Image, National Standard Format (NSF) or ANSI837 Claims:   A wide range of supported import formats allows EDI ClaimManager to work with almost any Practice Management System on the market.
  • Minimum Equipment and Software Requirements:  Can be used on any Windows 98SE/2000/XP based computer with high-speed internet access.
  • On Screen Claim Error Correction:   Claim data errors are easily identified on the screen with the error messages highlighted in red.  A simple claim editing screen allows correction of invalid or missing information to enable you to easily correct and resubmit claims.
  • Real-time Claim Status Tracking:  The EDI ClaimManager couples all the responses from the insurance carriers computer system to each claim.  For insurance companies that support on-line or batch claim status inquiry, you can easily check the current status of a claim.
  • Full Audit Log On Each Claim:  The EDI ClaimManager tracks every data element on an insurance form for changes to its content.  This provides an audit trail for claim corrections and resubmissions.
  • Online Claims Management:  The EDI ClaimManager is a total claims management system.  It follows the individual insurance claim from the minute it is transmitted, until it is paid.  At any point in time a status of the claim can be determined.  The system includes easy to create and understand management reports.
  • Revolutionary Claims Status Tracking System:  As any claim in the system changes status anywhere along the path from submission to payment, EDI ClaimManager will monitor the claim and set the appropriate status.   Inquiries are available by status to check on all the claims in a given status category.
  • Create and Print On-demand Claims Status, Request for Review and Proof of Timely Filing Letters:  With the selection of the letter type, you can generate a custom letter that contains all the necessary information needed to follow-up on a claim, request a review or provide proof of timely filing.  These features save hours in paper work creation, improves claim follow-up and reduces lost revenue due to timely filing requirements.
  • Upload, Submit, View, Edit and Resubmit Insurance Claims for a single system:  Rather than learn four or five different systems and their various reports, you can submit all your insurance claims (Medicare, BCBS, Medicaid and Commercial Claims) to a single easy to use claims management system.  You no longer have to transmit your claims into a black hole and hope they will be paid.  EDI ClaimManager tracks every claim it receives from beginning to the end.
  • 100% Paperless Claims Administration:  Single easy to read reports.  No need to interpret various reports from different insurance companies in order to understand the status of your claims.
  • Meets HIPAA Compliance Requirements:  The system supports the submission of the following HIPAA mandated capabilities: Claim Status Inquiry (ANSI 276/277), Real Time Eligibility (ANSI 270/271), Electronic Remittance Processing (ANSI 835) and Profession Claims (ANSI 837).
  • Lookup Capabilities for Referring Physician UPIN, Procedure and Diagnostic Codes, Insurance Carriers, Taxonomy Codes:  Easy to use online inquiry for lookups.  You no longer have to use another system or a manual book to find provider UPIN’s, procedures, diagnosis codes, insurance carriers or taxonomy codes.
  • Updated Status on All Claims:   Every status message associated with a claim is tracked as it moves from submission to payment and is attached in an easily viewable format.
  • WatchDog Totals by Week and Month:  Track the progress of the claim dollar amount totals of the claims submitted to compare against expected Weekly and Monthly practice totals.