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Clearinghouse as a commodity

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A clearinghouse should function similarly to a public utility. Like utility customers, clearinghouse clients expect extremely reliable service and rapid support if there is a service outage. Clearinghouses must be able to swiftly adjust to payer related problems and communicate with clients when downtime is expected or when a problem is detected with the data provided. In all cases, changes to levels of service needs should be handled by a knowledgeable and helpful customer representative. Etactics’ IntelliClaimⓇ clearinghouse provides this level of service.

 

 

Solve common problems through claim scrubbing, eligibility verification prior to claim submission, in-portal claim editing, and workflow management.

 

While some practice management systems are robust and independent, others lack needed or desired functionality. In such instances, a modern clearinghouse covers the gaps between what is needed on a claim and what the HIS or PM system natively generates.

IntelliClaim offers all of the following regardless of your pricing model and practice management or hospital information system:

 

 Glasses laying on top of a health insurance claim form
  • Claims Submission
  • Standard claim scrubbing such as CCI, LCD & NCD edits
  • Real-Time eligibility benefit verification
  • Real-Time claim status checks
  • Electronic Remittance Advice (ERA) delivery
  • Integration to the AppealsPlus™ denial management product
  • Comprehensive enrollment support
  • World class customer service
  • Custom programing services to meet your unique needs

Our client managers are with you from day one including implementation and ongoing support.

 

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We simplify and streamline the enrollment process including the verification of the receipt of ERAs and calling the appropriate payer on your behalf if there are problems.

 

After training, client managers are always available to answer any questions by email or phone. For more information, check out our testimonials and customer experience brochure.

 

Our standard claim scrubbing service applies appropriate edits to your claims, including National Coverage Decisions (NCD), Local Coverage Decisions (LCD), and Correct Coding Initiative (CCI).

 

Affected claims are returned to you promptly for corrective measures. These claims can be worked in our portal or from within your PM or HIS system by importing an ANSI 277CA file.Clients can also request custom edits, which can filter and highlight mistakes then place affected claims into a workqueue for correction. Alternatively we will correct the claim automatically before and continue with the submission.

 
 Onboarding graphic that explains the implementation process new clients go through when choosing IntelliClaim
 

Workflow and business intelligence improvement in identifying and appealing underpaid and denied claims.

 
 

AppealsPlus™ is a cloud-based solution that automatically analyzes ERAs, applies rules to place suspect payments and denials in appropriate work queues, and utilizes dashboards and key performance indicators to provide quantitative management and used to help drive decisions.

 

 

The word that most succinctly describes the healthcare industry is uncertainty.

 

The regulatory climate moves quickly and can change directions rapidly, leaving little time for providers and their patients to adjust. Providers don’t know if their patients will be able or willing to pay the bills after a procedure is performed. What most studies, vendors, and software companies  fail to take into account is that the definition of a denial is subjective. This definition differs by physician, biller, and institution.

 

Features Overview

A Software as a Service (SaaS) technology for rapid deployment without capital expense, so return on investment is immediate.

 

We'll take you and your team through a personalized four week long implementation phase to ensure that the solution is customized to your liking.

 

After the initial four week implementation phase you can continue to contact us with any questions or concerns you have. We pride ourselves on the customer service we bring to our valued clients.

 

 
 A graphic explaining the implementation process involved with AppealsPlus
 

We'll help you check the vital signs of your organization to monitor both the strengths and weaknesses of your revenue cycle.

 
 

 

We pass your data under a virtual MRI to help you uncover and prevent revenue leaks, provide education to define best practices, prepare for payer negotiations, calculate asset valuation, and discover red flags pertinent to merger activities with our Revenue Vitals Report technology.

 

 

Reports can be run in real-time and the denials discovered through Revenue Vitals can be worked through innovative work queues.

 

We can make the Revenue Vitals Report as detailed as you need. It's simple, give us an general idea of the information most important to your organization and we'll produce the report exactly how you want.

 

We only need two ingredients...

  • ANSI 835s

  • 7 - 10 business days

 Animation explaining what Etactics needs in order to create a comprehensive Revenue Vitals Report