Healthcare Claims Management

Enable healthcare providers to streamline claims processing with ease. The software offers a unified platform that automates claims submission, tracking, and resolution through a single intuitive dashboard.

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Claims management software is required for the healthcare sector to enable compliance, provide automated and easy access to the health records and medical claims in one place. The management of healthcare claims is a highly complex process. It can be simplified by using customized medical claims processing software in conjunction with a claim integration system. Customized medical billing systems with claims integration makes it simple to access a digital archive of all records.

To take one step towards building a better medical claim processing system, SalesPerform has come up with the idea of process driven automation to analyze and integrate CCLF data. By incorporating claims management software with customized edits into the workflow system, providers can thoroughly review every line of every encounter and ensure that each claim is coded correctly and contains the correct information before the claim is invoiced and submitted for reimbursement.

EMR system's ALLSCRIPTS and EPIC were used to keep digital version of the paper charts in the clinician's office, but epic was way better than ALLSCRIPTS in handling claims and improving the speed of payments. EPIC provides interdisciplinary and patient communication within the entire team and hence make it a better option than ALLSCRIPTS.

Benefits Of Healthcare Claims Management Process

Analyze claims with greater confidence and easily identify any possible errors well in advance of claims submission.

Optimize

Reduce the number of claim denials, corrections, and rebilling. Improve first-time pass-through rates by optimizing reimbursement.

Prioritize

Execute the most efficient workflow for your team and prioritize high-impact accounts with confidence.

Monitor

With automatic claims status updates throughout the adjudication process, you can improve productivity and cash flow.

Analyze

Increase reimbursements by analyzing denials and automating the process. Investigate the root causes of denials and act quickly.

Key Features of SalesPerform

CCLF Data Integration

CCLF (Claims and Claims Line Feed) files include claims for the ACO's assigned or assignable beneficiary population. The CCLF is used to assist active Shared Savings Program ACOs with coordination of care. Claims databases collect information on millions of doctors' appointments, bills, insurance information, and other patient-provider communications.

Claims Management & Approval Portal

Medical claims management means organization, billing, filing, updating and processing of medical claims related to patient diagnoses, treatments and medications. Without effective claims management in healthcare, patients wouldn't know what they owe and clinical offices wouldn't get the assets due for patient administrations.

NACHA File Generation

The ACH file format (or NACHA file) is a text file with ASCII text lines, where each line is 94 characters long and serves as a "record" to execute domestic ACH payments through the Automated Clearing House Network (NACHA). The five main record types that make up the ACH file format is header, trailer, batch header and trailer, and detailed transaction records. A NACHA file is one of the most common types of payment files and is used to execute domestic ACH payments through the National Automated Clearing House Association. It's a fast way for a business to pay vendors without having to use checks or a credit card.

Health Care Claim Payment/Advice (835) Transaction

The 835 Health Care Claim Payment/Advice provides detailed payment information about health care claims submitted to BCBSNC. The 835 Transaction may be returned for Professional and Institutional 837 Claim electronic submissions, as well as paper and electronic CMS 1500 and UB04 claims submissions. These files are used by practices, facilities, and billing companies to auto-post claim payments into their systems. The 835 Electronic Remittance Advice (ERA) provides information for the payee regarding claims in their final status, including information about the payee, the payer, the amount, and any payment identifying information.

Claims Analytics Data Warehouse

Physicians now file most or all claims through electronic data interchange (EDI), surveys show. The increased use of EDI has produced logistical efficiencies for both providers and payers, but payers have benefited most from the analytical capabilities enabled by EDI.

Medical Adherence

The medical adherence application is focused upon taking the medications correctly/timely or as prescribed by the doctor. This involves factors such as getting prescriptions filled, remembering to take medication on time, and understanding the directions.

Cloud Hosting

SalesPerform CMS is hosted on multiple cloud platforms, including OCI, GCP, AWS, and Azure. Our deployment process incorporates automated pipelines, with the goal of enhancing and expediting the deployment of applications.

Transparent Pricing

Scalable pricing designed for businesses of every size. Start free, upgrade as you grow.

No Plans Available

We don't have pricing plans available for Billing Healthcare at the moment. Please try selecting a different plan or contact our sales team.

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FAQ

Frequently asked questions

01.

What do we refer to as medical claim management?

The organization, billing, filing, updating, and processing of medical claims relating to patient diagnoses, treatments, and medications is what medical claims management entails.

02.

What is the claims management process?

A claim management process is a system or process through which an insured person's claim for compensation for an insured loss or damage is received, processed, and verified before being authorized for compensation.

03.

What is CCLF data?

Claims for the ACO's assigned or assignable beneficiary population are included in CCLF files. The CCLFs' goal is to help active Shared Savings Program ACOs with care coordination.