Bring Efficiency to Your Payer Billing and Denial Processing
Regardless of the “standard” claim forms and electronic submissions, every payer has their own requirements which must be met to get paid. Our Revenue Cycle Management solution is designed to allow each payer’s requirements to be configured to improve cash flow and efficiency when working transactions assigned to payer responsibility.
The rules for each payer to compose 837 claims for submission (for both 4010 and 5010 standards) or print CMS-1500 or UB-04 forms can be defined within the application. Once transactions are clean and compliant, they are posted and claims are generated and submitted to the payer automatically. Additionally, the expected contractual adjustments can be posted immediately, allowing views of accounts receivable to reflect the actual cash that can be expected.
The billing system supports 4010 and 5010 835 electronic remittances with automatic posting of payer payment adjustments along with claim payments, adjustments and reason codes per service line. Rules can then determine the next disposition of the claim, which includes placing denials to the Claim Error Workqueue or Claim Appeal Workqueue for user intervention, automatically processing the claim to the next payer or even closing the claim while automatically changing the transactions to be patient or client responsibility. And if the payer did not pay you the expected amount, not to worry — the Reimbursement Exception Workqueue will allow efficient management notification of all reimbursement not meeting your contracts for follow-up. Payer billing also includes functionality to post EOBs manually, print EOBs as needed and create refunds. Management functions allow outstanding AR by payer to be viewed and worked, with automatic actions to streamline workflow when no payer response is received. Bring efficiency to your payer billing and denial processing with the TELCOR Revenue Cycle Management solution.
Claim Submission
TELCOR supports both professional and institutional claim submissions via 4010 or 5010 837 claim submission interfaces or corresponding printed claim formats. The generation of claims occurs after all transactions have been verified and processed by the rules engine and occurs according to the user-defined schedules for each claim submission recipient. You will receive an email of the status of each claim generation and transferred status. Submitted claims are easily monitored with the Monitor Outstanding Claims function, which ages claims submitted by user-defined aging intervals and payers. Drilldowns allow outstanding claims to be investigated, but automatic actions can be defined when no payer response has been received within a user-defined time frame.
Payer Remittance
TELCOR supports an unlimited number of 4010 and 5010 835 remittances from payers or EOBs can be manually entered with functionality designed to streamline entry. The 835 remittance files are processed automatically and displayed in summary and detail for user verification from the Electronic Remittance Workqueue. All remittance is posted at the service line to ensure adjudication of each transaction with metrics for statistical analysis by management. While remittance received electronically can be automatically posted, the TELCOR application takes workflow efficiency further through rules that can be defined that will process the claim to the next action automatically. Payer remittance also streamlines payer payment adjustments, interest and refunds.
Working Denials
The Claim Error Workqueue allows easy corrections when information can be updated and the claim is resubmitted with tools for assignment, error categorization and easy update and resubmission. Claims can be assigned to personnel for monitoring and management of the process. The Claim Appeal Workqueue allows multiple levels of appeals to be managed. Appeal letters can be pre-configured and automatically generated along with accompanying claims based upon user-defined schedules. Appeal levels and turnaround requirements can all be defined per payer to allow management to ensure appeals are sent and received according to the payer requirements. The Monitor Appeals function allows a statistical view by assigned to or appeal classification of appeals in process and the associated dollars that are outstanding.
Payer Contract Monitoring
The TELCOR application allows the expected allowed amounts to be defined for each payer and procedure. Upon remittance entry, any amounts that are outside the definitions and also exceed the tolerance levels defined are automatically flagged for management review. The Reimbursement Exception Workqueue allows management to review and approve each exception, while providing tools to streamline the next steps (e.g., contact payer, appeal claim). In addition to real-time exception management, the Claim Remittance Analysis presents averages and details by payer and procedure of expected, allowed, paid, contractually adjusted and other adjusted amounts with drilldown to details for analysis. This allows efficient monitoring of payer reimbursement practices with your organization over time.