Associated Data Services,LLP EOB Solutions


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Associated Data Services,LLP EOB Solutions

  1. 1. Confidential 1 Healthcare SingleVIEW Methodology Presented By: Associated Data Services, LLP Revenue Cycle Check and Balances for Healthcare Receivables
  2. 2. Confidential 2 Revenue Cycle Check and Balances for Healthcare We provide a complete Financial Platform that balances and reconciles ALL Payments with Claims Our solution is a timely and accurate accounting of all financial transactions for accelerating the posting and revenue recognition for the provider …
  3. 3. Confidential 3 What we do… • We provide a complete electronic environment • Convert and Process – ERA’s – Paper – Patient/Self Pays – Correspondence • Archival & retrieval • Detail level search and analysis • Controlled work queue environments • Balance and Reconciliation • Match and Review through a Single View environment • Generate • Post
  4. 4. Confidential 4 System Highlights • Both ERA and Paper Documents • Paper Portal provides Real-time view • Proven and stable environment – Over 3m EOB’s processed monthly – Over 16 years in business – No 3rd party software – business totally owned • We shorten the revenue cycle process by providing NEXT day processing • Highly configurable system – Designed to conform to customers environment – Configurable business rules – 837 files • Implementations – 6 weeks or less • SingleVIEW Side-by-Side Comparisons • All transactions stored for 7 years • Complete Search Engine capabilities • HIPAA II Compliant - September, 2010 • Auto-Posting
  5. 5. Confidential 5 Process Flow …
  6. 6. Confidential 6 Healthcare Revenue Cycle Co-pay Claim Created Sent to Clearing House Claim sent To Payer Payer Review Claim & Submit Payment Decision EOB w/Check EOB w/ACH ERA w/Check ERA/ACH EOB/Zero Pay ERA/Zero Pay Correspondences Bank Lockbox Provider Secondary Denials Self Pay Write-Off SingleVIEW
  7. 7. Confidential 7 Islands of Information - Today Paper EOBs Bank Account ACH/Checks Deposits Accounting System (Auto Posting) Imaging System Customer Service ERA’s Secondary Processing Denials/Appeal Process Co-Pay Self Pay
  8. 8. Confidential 8 Healthcare Revenue Cycle Flow Paper EOB ERA Secondary Correspondences Denials Self Pay Reporting Co Pay Input Output Provider Payer Bank Provider Payer Bank • 837 File • Sample 835 Posting File • Sample Self Pay Posting File • Denial Codes • Co-Pay Information • ERA Files • Secondary Letter • Self Pay Billing File SingleVIEW • ERA • Paper EOB • ACH to Bank • Paper Checks • Zero Pays • Correspondences • EOB Images • ACH Files • Index Files • Rescan Images • 835 Posting File • Paper EOB • ERA • Self Pay Posting File • Secondary Processing Files • Denial Re-submission • Secondary Claims • Paper • Electronic • Rescan Request • Billing File for Payment
  9. 9. Confidential 9 ProviderProvider ERAs 835 PayersPayers 837/Printer Files/ Billing Database ACH Consolidated 835 EFT Paper EOBs Check BANKBANK Lockbox Scanned paper EOBs 835 Consolidate 835 Denial Detection Parsing 837/835/ACH/Printer Files Secondary Detection Un-matched Exception Handling Claim - Remit - Payment Reconciliation Reports ERA Processing CereSoftCereSoft Paper EOB Conversion Data validation with Claims Create 835 EOB Processing Web portal Status/ Reports EOB Images
  10. 10. Confidential 10 The Financial Connection Monthly, Weekly or Daily Financial Summary
  11. 11. Confidential 11 This is paper checks without EOB’s. This tells us there may be ERA’s to be re-associated This tells us that an EOB arrives but without a check This is the all paper section that flows from the lockbox This is non financial documents that are in a paper format This is EOBs with the payer paying zero amount This is all the paper self/private pay This is where we had paper EOB with a check This shows the total payments made with a paper check This shows the total payments made via an ACH transaction This shows the total ERA’s process This shows the total claims process that was matched and un-matched
  12. 12. Confidential 12 There is a Difference Today With SingleView
  13. 13. Confidential 13 Cash Balancing SingleVIEW Methodology
  14. 14. Confidential 14 Main View Cash Balancing
  15. 15. Confidential 15 The ICONS To view all claims/EOB that are on the system To view all payments that were process on the system To view all denials that were process on the system To view all secondary found during processing of EOB To view all cash process from all areas from Check, ACH and Patient Pay To view from the claim type (Paper or ERA or Patient) in balancing the cash that was process To view all work that are currently available in all work queues within the system To view all the paper that was process that includes Paper EOB, Correspondences, and Patient Pays.
  16. 16. Confidential 16 Cash Posting – Main View Number of Checks Deposited Breakout of Checks to EOB/ERA Total Patient Claims associated To the Checks Number that did not have 837 claims associated to payment Total Deposit for all funds Number of accounts that had 837 data to match with the EOB and Check
  17. 17. Confidential 17 Cash Balancing – Historical View
  18. 18. Confidential 18 Check Payment View Click Icon to see claim associated to check Click Check Number To View the Check Click F under File To see 835 Conversion
  19. 19. Confidential 19 Payment View with Check Image
  20. 20. Confidential 20 Account associated to Payment Click on Account Number to see 835 or Image and the Check No Claim Paper EOB with Check
  21. 21. Confidential 21
  22. 22. Confidential 22
  23. 23. Confidential 23
  24. 24. Confidential 24
  25. 25. Confidential 25 All accounts that were associated with the check that were process
  26. 26. Confidential 26
  27. 27. Confidential 27
  28. 28. Confidential 28 SingleVIEW Methodology 837/EOB Image or 835/Check
  29. 29. Confidential 29 Demonstration Customer Portal