EMEDIX RCM offers full functionality in one easy to use package so that your organization can manage and reduce denials, receive faster payments and recover lost reimbursements.
Claims (ANSI 837)
RCM capabilities include uploads of professional and institutional claims by manual input (providers without a billing software program) in print image format, or ANSI format. Non-standard files are up/down converted for full HIPAA compliance.
We submit all claim files to payers in real time and according to payer specifications, 24/7/365 unlike other clearinghouses that submit claims once or twice per day.
Easily submit secondary and tertiary claims within RCM.
Enjoy the control of claims assignment within the application. Claims can be sorted by user in a variety of options…i.e. by payer type, dollar volume, rejection type, alpha character, NPI number, Facility etc.
Our comprehensive edits engine is designed so that you will immediately see a decrease in rejected claims.
Clinical code scrubbing and include:
- HCPCS Validity – checks claim information for the most current
- Level I (CPT-4) and Level II (HCPCS) procedure codes.
- ICD-9 Specificity – compares the diagnosis codes on the claims to the ICD-9 revision guidelines.
- Medical Necessity – compares claim information to LMRP policies.
- Correct Coding Initiative (CCI) – compares claim information to CCI edits developed by CMS.
Why wait until tomorrow, when you can optimize your claim submission flow today?
Real Time Eligibility (ANSI 270/271)
Pre-check eligibility available before claim is sent to payers and can be automated.
On-demand eligibility is available from the claim with no data entry.
Response is returned in human readable form and linked to the claim.
RCM will flag the claim as an error if non-eligible response is returned.
Real Time Claim Status (ANSI 276/277)
Check claim status within the application without data entry.
Automatically check payer claims at set intervals.
Payer status is attached to each claim.
Reports can be customized and be set to auto-run.
Notifications appear when the report run is complete.
Electronic Remittance Advice – ERA (ANSI 835) Remit Manager
EMEDIX Reimbursement Solutions receives ERA files from payer 24/7/365 and are forwarded to the provider’s account immediately.
All remits are available for download through our ERA repository; Remit Manager.
Remit Manager stores all 835 files and makes them available to providers at any time if you need to download again.
Remit Manager can translate any 835 received into a standardized human readable electronic EOB, searchable by payer, check number, patient or provider.
Options include view and print a batch of remits or generate a specific remit for a single patient to send to the payer.
Remit data is automatically attached to the corresponding claims, allowing creation of secondary claims without the need for PM involvement. No more hassle of the tedious task of secondary claims creation and filing!
Convert all of your paper explanation of benefits to a remittance file (ANSI 835 ERA) and auto-post within your billing software program.
Reporting and Analytics (RCM Report Gateway)
Create standardize reports or customized reports according to user parameters.
Reports can be filtered and sorted according to user specifications; reports can be viewed online or saved to your own computer system.
RCM Report Gateway provides an in-depth advanced accountability of claims sent through EMEDIX Reimbursement Solutions.
Faster, cleaner submissions add up to financial results—our customers report reductions of up to 15 AR days.
We are so confident that you will experience an increase in claims quality that we only charge for accepted claims!