Revenue Performance Advisor

This solution helps reduce eligibility-based denials and the subsequent costs incurred by reworking them. It also helps reduce bad-debt write-offs from bills for uncovered services that go unpaid. You can create batch requests or real-time requests to over 2,200 payer connections at the point of service or use the easy-to-code API that integrates with your EHR. The API can be automated to deliver a continuous stream of near real-time responses and update the practice’s patient files in bulk. Responses are also stored for additional workflow tasking or reporting.

Claims that are validated and scrubbed before submission typically get paid faster. We provide an easy-to-use claims management solution that includes Medical Necessity and Correct Coding Initiative edits. This helps you submit more complete, accurate claims on first pass to avoid timely and costly resubmissions. You’ll have increased visibility into the entire process, making it easier and faster to get the job done.

Patient statements are designed to help you collect the patient’s responsibility and improve revenue performance. Easy-to-read statements that educate patients on their financial responsibility increase the chances of higher payment and fewer customer service calls.

The rejections and denials solution is designed to improve performance by automating your rejected and denied claims process and support increase staff efficiency and accuracy. Your staff can work by exception, so they can quickly spot any rejections and validate and resubmit within minutes. Our in-depth drilling/exporting functionality allow for critical analysis of denials.

Get more complete, accurate claims on first pass to avoid timely and costly resubmissions. You’ll have increased visibility into the entire process, making it easier and faster to get the job done. Paper claim fees are based on usage.

Attach documents within the solution, including Workers’ Compensation and medical claims, to streamline staff workflows. Users select the document, associate it with the correct claim, and send it to the payer electronically. We will fax or mail the document for participating payers who don’t accept digital attachments.

Our solution uses AI and machine learning to analyze a provider’s historical remittance data to predict which claims are likely to be denied before they are submitted to the payer. Once identified, those claims are flagged for reviewing staff and added to the claim history, along with any associated rejections. This helps reduce denials and optimize claims submissions. It also provides actionable insights to help you better identify and mitigate potential denials before they happen.

Receive near-real-time, end-to-end visibility into processes and trends that impact your provider performance. This greater level of insight helps optimize productivity, billing, patients’ experiences and your bottom line. Benchmark Analytics features more than 40 reports that track dozens of KPIs. Each report links to claim-level data to easily identify root causes or to fine-tune front- and back-office processes. Benchmark Analytics measures performance throughout the revenue cycle, including clearinghouses, payers, peers, reimbursements, patient payments and your practice.