Claim Lifecycle Manager

Our Core Values

Our Expertise

Our core competency is our knowledge of the X12 transaction set, payer connectivity, understanding what the payers—many with their own interpretation of X12 standards—will accept, and getting claims paid.

Fast, Easy & Complete

Our web based solutions are designed with the end user in mind. From enrollment to eligibility verification through to claim adjudication —along with many embedded work flow management and reporting tools—our intuitive user interfaces are easy to learn and understand—and provide fast processing of all your transactions.

Support

We strive to earn your business every day through responsive and knowledgeable customer support. Our success is based on your satisfaction with every encounter—whether you are a long term customer or a prospective customer making a first time inquiry to our Sales Division.

Customization

Our solutions are designed so they can be customized to meet your requirements. We understand that our customers and business partners have varying needs.

The Claim Lifecycle Manager is our premier web based service that provides our customers with all the tools and functionality necessary to manage the claim side of their business—instead of the other way around.

It offers a complete end-to-end claim life cycle solution—from enrollment to eligibility verification through to claim adjudication:

Eligibility verification for establishing patient coverage and verifying subscriber information.

Connectivity to all commercial and government payers that accept professional, institutional and dental electronic claims. We also offer print-to-paper and forwarding services to payers that do not accept electronic claims.

Customized claim and payer specific solutions to meet your needs. We accept both 837 and non-837 files. Also, if your billing software is sometimes unable to correctly report payer specific required information on claims—we can implement solutions on our end to fix those problems.

Claim Scrubbing and On-Line Editing for catching errors that will lead to payer rejections and denials—and making corrections before claims are forwarded to payers.

On-line claim management and tracking that allows you to quickly find and retrieve any claim or group of claims. Determine the status of any claim that has been forwarded to a payer. Track complete claim history from claim submission through claim adjudication.

Work Flow Management that allows you to assign claims to staff for follow-up. Add status and other follow-up notes as needed. Monitor the status of assigned claims.

Electronic Remittance Advice (ERA) processing for downloading 835s to facilitate auto-posting—as well as for providing human readable ERA reports for manual posting and other purposes.

Analytical Tools and Reports are available from any computer with web access. Any information about the claim side of your business—revenue, comparisons of payer reimbursements by service, rejections and denials, the most common reasons for claim errors and denials, staff productivity, audit trails—is always right at your fingertips.

Flexible user interface technology. Options include private labeling, interfacing all or parts of our services/UI from anywhere within your application, enabling/disabling of UI features and functions, auto logons, Web Services, FTP, HTTPS, etc.

Features & Benefits

Eligibility verification that provides fast and easy access to payer eligibility and benefit information:

Reduce registration errors and lack of insurance verification.
Verify that subscriber information is correct and complete before claims are submitted.
Establish co-payment and coinsurance amounts.

Unparalleled payer specific claims scrubbing and on-line editing features that significantly reduce the number of denied claims:

Accelerate cash flow by getting more claims paid on first submission.
Reduce overhead costs associated with having to rework and resubmit claims.
Reduce total claim submissions.

On-line claim management and tracking that enables you to manage your claims by exception:

Quickly identify and assign newly rejected, suspended and denied claims to your staff for follow-up.
Determine the status of any claim in process.
Add notes for follow-up.
Manage claim work flow and monitor follow-up by your billing staff.
Maintain claim history audit trails.

An abundance of easy-to-use analytical tools and reports that give you ownership of your claims processing—instead of the other way around:

Train your staff on the most common reasons for rejections/denials.
Measure staff productivity.
Manage your denials.
Create reports using any claim field.
Compare reimbursements and denials by payer.
Generate audits itemizing all error corrections, payer responses, assignments and notes—the who, what and when—for either a single claim or a group of claims.