Revenue Cycle Management

Easy. Flexible. Insightful.

Key Points!

PATIENT SCHEDULING & REGISTRATION
BENEFITS & ELIGIBILITY VERIFICATION
PATIENT ESTIMATES, CO-PAY AND DEDUCTIBLE MANAGEMENT
PATIENT VISIT & CASE MANAGEMENT
PATIENT ENCOUNTER CAPTURE
FEE SCHEDULES, CODING AND RULES BASED EDITS
CLAIMS MANAGEMENT
ELECTRONIC SUBMISSIONS
CLAIMS STATUS, APPEALS AND DENIALS MANAGEMENT
PAYMENT PROCESSING
PATIENT BILLING & STATEMENTS
BANK RECONCILIATION AND A/R MANAGEMENT

Claims Management

Dynamic Capture: Capture claims through an easy user interface that automatically pulls in all key patient, provider, and physician data along with coding links to enforce billing rules based on your fee schedules in an integrated system with the ability to capture all pieces of the HCFA 1500 in a single screen for paper claims.

Electronic submissions to thousands of commercial, Blue Cross, Medicare and Medicaid Payers. We will process your paper submissions automatically to payers that need a physical claim submission.

Clean Claims: 99%+ clean claims submission rate. System rules capture errors before they are submitted. System dynamically encodes payer rules and procedures needed for diagnosis and HCPCS codes.

Fee Schedules: Integrated fee schedules provide accurate billing and patient estimates. Fee schedules automatically updated for medicare rules. Apply rules-based logic to determine proper fee schedules to use.

NCCI: Automate NCCI coding policies on current coding conventions, coding guidelines, national and local Medicare policies (NCDs and LCDs), and standard medical and surgical practice.

Claims Workflow: Automate claims workflow, billing rules, denials and appeals, patient statements. Automatically assign tasks to billers and coders to review any exceptions based on claim scrubbing feedback.

Payments/ERA & EOB: Automate application of 835 remittance payment messages to outstanding claims using a powerful matching engine to match one to many and many payments to many claims with integrated exception management. Auto generate secondary claims and patient bills using ERA. Process EOB and automate denials processing by intelligent use of EOB data.

Electronic Claims Processing: Upload claim information in any format from CSV, XML, EDI and other proprietary HMS systems.

A/R Management: Real time dash boards inform you proactively on due claims and bills, Avg Days to Pay and Bill, etc. with the ability to slice and dice, roll up or drill down based on aging, balances, payers, plans, patients and any other criteria.

Collections Workflow: Automate reminders to patients and follow ups on missing payments from payers. Define strategies with actions and automated events and segregate portfolios. Track agent productivity and automated dunning letters. Reduce days to pay and average costs. Get cash faster!

Learn More About coAction RCM

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