Medical Claims Management

The AdvancedMD^® Claims Center provides the most convenient way to track and manage medical claims from posting through payment.

Track Claims From One Convenient Screen

From the Claims Center, you can do all of the following:

• Review claims - If a provider or other employee is set for charge review, charges posted will show up here for review before final posting.
• View unbilled claims - Claims that are incorrectly posted with errors, such as a service date outside the range of insurance coverage are refused and show up on a convenient work list. Claims rejected because of problems found by the Claim Inspector also show up on this unbilled list.
• View exclusions - If the clearinghouse discovers errors and does not bill a claim to an insurance carrier, that exclusion will show up on the exclusion work list.
• Track claim runs - The Run Alerts tab on the Claims Center lets you track claim runs and includes alerts for potential problems. The Track Claims feature prompts further investigation when payments have not been received after a user defined period.
• Keep track of all reports from carriers and the clearinghouse - The EDI Reports tab collects all the reports for electronic claims in a single location. This allows you to easily track the process of claims through the clearinghouse and carrier when using electronic remittance.

Reduce Denials With the Claim Inspector

The AdvancedMD^® Claim Inspector scrubs your claims before you hit submit. It includes more than 400,000 edits for CCI, HIPAA, LMRP, and carrier-specific problems. All this makes it easier to fix your claims prior to submission, which means fewer denials.

No-Hassle eClaims

For rapid claims payment, use AdvancedMD^® eClaims. We offer top clearinghouse partners and secure Web transmission direct from your desktop. Say goodbye to the end-of-day modem hassle forever!

With AdvancedMD^® eClaims, you can enjoy:

• Rapid online reports for each claims submission batch
• Denial management reports
• Electronic auto-posting (ERA) of payments directly back to charges (where available)
• Reduced overall reimbursement cycle time

The following electronic transactions can be seamlessly accessed from within the medical office software:

• Claims (HIPAA ANSI 837): Electronic claims submission allows you to submit claims daily that means faster reimbursement. In the limited cases where payers do not accept electronic claims, a practice can elect to have these claims automatically printed and mailed by AdvancedMD^® Of course, practices can still print demand claims on HCFA 1500 forms for direct submission.
• Electronic Remittance Advice/ERA (HIPAA ANSI 835): With ERA the practice receives an electronic remittance (i.e. an electronic EOB) transaction that can be reviewed in the system and automatically post payments by procedure. Automatic Posting this data improves accuracy, reduces data entry costs and results in rapid patient statement processing. There is no need to wait for the paper EOB to arrive in the mail.
• Patient Statements (Not a HIPAA transaction): Electronic statements allow your practice to automatically generate and mail daily statements while avoiding the costs of stamps, stationery, envelopes, printing, sorting, stuffing and addressing.
• Eligibility (HIPAA ANSI 270 Request/271 Response): Prior to seeing a patient, obtain information on a patient's eligibility as well as their co-pay, remaining deductible and other coverage details.
• Get the codes you need instantly, for no extra charge. Imagine having a completely searchable, easy-to-use online codebook right in your billing software. That's what you get with AdvancedMD^®. Your subscription includes the following codebooks at no extra cost:
  • ICD-9
  • CPT
  • HCPCS
    
• Easily search codebooks and import only those codes you need on your Online Charge Slip. This helps you keep your pick lists short and manageable. We'll provide all the annual code updates. Our search utility makes it simple to find the new, deleted or changed codes.

Use Whichever Claims Forms You Need

AdvancedMD^® supports both HCFA and UB92 forms so individual providers and institutions alike will find it easier to bill appropriately and get proper reimbursement. Continue using your own charge codes-simply map them to the appropriate revenue codes during setup and carry on as you always have, without retraining your staff. Our UB92 support is the most customizable around.