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2260 Apollo Way, Suite 103 |
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2260 Apollo Way, Suite 103 |
We provide payers a full range of customizable products and services — ranging from traditional gateway processing to complete portal solutions for your provider clients. We offer our payer partners state-of-the-art, secure, web-based eligibility and claims processing solutions that do not require installation by your provider clients. ClaimRemedi provides responsive, experienced and knowledgeable support to both you and your clients.
Our comprehensive rules engine significantly reduces the number of incorrect and incomplete claims you receive. New rules can be quickly implemented on demand to cover one or any number of plans/products you process. Flexible user interface technology allows you to integrate our services with the “look and feel” of your services. Options include private labeling, interfacing all or parts of our services from anywhere within your services, enabling/disabling of user interface features and functions, auto logons, web services, FTP, HTTPS, etc.
Connectivity to all other commercial and government payers that accept professional, institutional and dental electronic claims that process eligibility requests. Claims scrubbing and on-line editing that catch errors and make corrections before claims are forwarded to you. Claims workflow management solutions provide a complete claim history from claim submission through claim adjudication for tracking claims and assisting in assignment of claims that need staff follow-up.
Analytical tools and reports help manage denials, measure staff productivity, provide audit trails and identify the most common reasons for claim errors and payer denials.
We also provide conversion of non-837 claim files — NSF professional, institutional and dental formats, professional and institutional paper print images, EMC, and a variety of other non-standard formats. Our print-to-paper services for professional, institutional and dental claims provide claim submissions to payers who do not accept electronic claims.
ClaimRemedi offers providers Electronic Remittance Advice (ERA) processing for downloading ERAs into practice management/billing systems to facilitate auto-posting — as well as providing human readable ERA reporting tools for manual posting and other analyses.
Whether you use our services only for traditional gateway processing or also implement our portal solutions, ClaimRemedi’s front-end claims processing is designed to provide you with cleaner claims that meet all of your 837 X12 implementation guidelines — both in regards to syntax and data content.
ClaimRemedi’s proprietary rules engine eliminates incorrect and incomplete claims on the front-end, significantly increases first-pass and auto-adjudication rates, reduces re-submissions and decreases suspense processing.
All code sets (CPT, HCPCS, Modifiers, ICD9, Revenue Codes, DRGs, Occurrence Codes, etc.) and a huge library of industry standard edits are maintained by ClaimRemedi and updated prior to code change effective dates. All rules are date sensitive. Rules can be quickly added, deleted or changed to meet your specific requirements. Change requests can be implemented within 24 hours.
All rules can be plan specific. Rules that apply to only one of your plans are applied only to claims for that plan. There is no need to maintain a separate system for each of your plans. Input and output options are customizable to accommodate your existing business processes.