If you are a healthcare services provider, you must be familiar with medical claim denials that cut into your revenue. While coding and billing errors constitute the main reasons for claim denials by insurance companies, another key reason is inadequate understanding of the insurance company's adjudication logic and reasons for claim denials.
Using a good medical management or practice management software not only reduces errors in billing and coding, but can also serve claims filing and readjudication functions thereby greatly reducing your claim denials.
We know how insurance companies work
At Dev-Fx, we partner with a leading healthcare management company with over 27 years of experience in the healthcare and industry. Our health care information system identifies the algorithms utilized by the healthcare insurance industry and maps all the rules that drive benefit coverage and payer specific clinical and financial rules.
This vast experience allows our healthcare management software to perform greater in-depth analysis and research, resulting in increased precision and consistency.
Benefits of our Healthcare Management Software
- Our rules based engine tracks, monitors and updates proprietary educational tools to increase individual performance
- Appeal Tracker
- Identifies collectible items
- Auto corrects coding relationships
- Distributes denied procedures to appropriate collectors
- Performance evaluation per collector
- Fixed cost analysis
- Electronic tickler system
- Comparative analysis of cost vs. performance
Features of our Healthcare Management Software
- Our medical management software establishes industry specific standards and guidelines for coding, pricing, billing, reviewing, auditing and managing medical episodes.
- We leverage our proprietary database and expertise to provide health care industry comparative pricing tools, claims editing systems, utilization protocols and specialty specific clinical, coding, pricing and reimbursement guidelines.
- Our databases maintain comprehensive health care industry payment information, including usual and customary reimbursement schedules for health care products with comparative reimbursement pricing guidelines for procedures by zip code area.
- Artificial intelligence enables our Rules Based Engine to apply sophisticated, clinical and financial based edits to analyze coding relationships by insurance company, employer sponsored benefit plan provision-exclusions-limitations, coverage issues, utilization guidelines and line item information contained in the insurance claim or remittance statement.
We know which areas to target to increase your returns.
With our years of experience in the healthcare industry, we have identified the adjudication logic that defines benefit coverage, medical necessity guidelines, coding relationships, bundling logic, multiple procedure rules, schedules of reimbursement and reasonable and customary charges. Our health care software identifies all these areas.
With this information, we readjudicate EOBs. During our readjudication process, our health care and medical software will review claim history files and system databases to identify inappropriate adjustments, write-offs, underpayments and missed revenue opportunities.
In fact, the use of our healthcare management software will increase your bottom line by as much as 24%.
Outsource healthcare software services to Dev-Fx
If you are thinking about outsourcing healthcare management software or practice management software, contact us for more information. Simply fill in the inquire here form and our Client Engagement Team will contact you soon. We will facilitate the outsourcing process by answering your queries, assisting smooth flow of information and catering to all your healthcare software requirements.