Revenue Cycle Management

In today’s business climate, it is more important than ever before to understand and collect reimbursement for all the services you have provided. Claims remittance management is the key to more rapid and efficient processing, reconciliation and cash flow, yet, in many cases, this is a complex, labor intensive that leads to delays and revenue leakage.

Systemware easily integrates to your bank’s lockbox and manages paper EOB scanning and conversion to EDI 835 files directly via OCR technology. Our solution can also capture EDI 835 files received direct from the payers and re-associate these to payments that pass through your bank’s ACH network.

Once converted or received, the files are matched against EDI 837 files to automatically pre-adjudicate payments against open claim items. Once matched, a postable file is generated and made available for you to download into your billing or practice management system.

This solution also allows for balancing of financial transactions, to ensure that payment for each batch of EOB or electronic remittances has been received and deposited into your accounts.

After initial posting, payment posting staff can research denials to determine the best way to file for secondary claims coverage. The secondary claims data generated by the billing system can be loaded into our solution and automatically applied to the appropriate billing form - CMS 1500 or UB 04. Additionally, the primary EOB image is automatically matched to the secondary claims file, and the entire file is prepared for print production or electronic submission.

Through the provider’s portal, payment posting staff can access their work to view documents, research claims and manage items that did not process automatically. Detailed index data is captured for each item, making finding a specific claim and remittance fast, easy, and accurate. Each transaction for each patient can also be viewed from the portal, showing the relationships between the claims, remittance, secondary claims, secondary remittances and patient pay components.

Systemware also includes a number of standard remittance reports as well as operational dashboard for exception tracking, denials management and HIPAA compliance. These reports can be generated on demand or scheduled to run at regular intervals.

With Systemware, all documents and content are stored in a secure, centralized repository making it easy to search and find EDI-based claims and remittance data as well as all captured images. This active archive manages the complete lifecycle of all your information for retention and disposition. In addition to managing and archiving, this solution also indexes vital information such as patient name, charge codes, denial and reason codes, etc. increasing your reporting capabilities.