Medical Banking
Traditionally, there’s no such thing as a quick buck. But with Systemware’s Medical Banking solution, you’ll be able to realize a new revenue stream by offering healthcare providers enhanced lockbox remittance services. In addition to the traditional imaging and deposit services, now you will be able to quickly transform these images into data files for automatic posting and reconciliation to their billing system. As a result of this service, providers have one place to access all of their claim, payment and denials information while greatly reducing their days outstanding - getting paid more quickly.
Quicker for them, bucks for both of you.
Systemware captures, converts, indexes, matches and stores all EDI 837 claim files, paper EOB images, EDI 835 remittance files and BAI2 deposit reporting files in a central repository. Paper EOB’s are converted to EDI 835 files, Electronic Remittance Advice (EDI 835 files) received from Payers, along with the converted paper EOB’s are matched to open claims, creating a postable EDI 835 file that is balanced against deposit information. Providers can then upload these pre-adjudicated files into their billing system.
For Secondary claims, providers can upload claim data to Systemware where it is mapped to the appropriate claims form (CMS 1500 or UB 04 forms), matched with the primary EOB image and the entire file is prepared for print production or electronic submission.
Systemware streamlines the processing of paper EOBs by recognizing and extracting detailed patient information delivered from your lockbox imaging process. Any data extraction errors are manually corrected so as to deliver a complete, valid 835 file to your medical banking process. The Medical Banking solution also creates HIPAA ready patient level snippet images making review of specific patient information fast and easy.
Systemware captures, indexes, and stores patient level claim information in EDI 835 format as well as reconciling the remittance to the claim and payments. You’ll also have on-screen access to the original data file or virtual images of the claim and patient billing files.
Systemware streamlines the payment posting activity by pre-adjudicating the remittance process, significantly reducing manual data entry and increasing the number of transactions per FTE. A postable file is automatically generated for your provider’s practice management or billing system, and matched to the line item claim detail.
Systemware also provides exception handling for all non-matching files through the Web-based provider’s portal. Here payment posters are able to quickly resolve all non-matching files and release them back to the automated process for creation of a postable 835 file.
Systemware captures secondary claim file data from providers billing system and automatically generates a secondary claim file onto appropriate billing forms (CMS 1500 – UB04). The solution automatically matches secondary claim files with the appropriate primary EOB image and generates a new document in PDF format for submission to payers.
Claims, remittances, checks, electronic funds transfer information as well as supporting documentation are immediately available through a provider’s portal to support payment posting activities and subsequent claims research. You’ll no longer have to look in different systems or through stacks of paper, since providers can view all documents though a single system and see how each part of the transaction relates to the others. Providers can now store and retrieve all information in patient level snippets, making search and retrieval fast and easy.
Regulatory compliance is made much easier with our role-based authentication and detail access reporting with audit trails for HIPAA compliance. All records are tracked to show who accessed them and at what time.
A standardized file allows any lockbox imaging process to integrate simply within the Systemware solution. Image and batch header files from the lockbox process are used to initiate the automated remittance processes for Provider customers.
