Automating HealthcareRemittance Processing                       TAWPI Healthcare Payment Automation Summit               ...
Providers Landscape•  7000+ hospitals, clinics, surgery centers, etc.•  450,000+ physicians in private practice   –  Half ...
Why Medical Banking•  Currently banks provide:   –  lockbox services such as deposit of payments   –  imaging of checks   ...
Medical Banking
Extended HC Lockbox•  Medical Banking Application   –    Capture & indexing of EDI 837 files   –    Converts paper EOB’s i...
Online Providers Experience•  Provider Portal (Bank Branding)   –  Manage processing exceptions      •  837 /835 matching ...
Copyright © 2009 Systemware, Inc.   13
Medical Banking•  What banks SHOULD provide:  –  Data conversion      •  of paper EOB’s into EDI 835 files for posting to ...
Automating healthcare payment and claims remittance processing   systemware's medical banking automation summit report
Automating healthcare payment and claims remittance processing   systemware's medical banking automation summit report
Automating healthcare payment and claims remittance processing   systemware's medical banking automation summit report
Automating healthcare payment and claims remittance processing   systemware's medical banking automation summit report
Automating healthcare payment and claims remittance processing   systemware's medical banking automation summit report
Automating healthcare payment and claims remittance processing   systemware's medical banking automation summit report
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Automating healthcare payment and claims remittance processing systemware's medical banking automation summit report

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Check out the latest report on Automatic healthcare remitance processing by Gordon Sellers - Director, Healthcare and Medical Banking Solutions at system ware.

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Automating healthcare payment and claims remittance processing systemware's medical banking automation summit report

  1. 1. Automating HealthcareRemittance Processing TAWPI Healthcare Payment Automation Summit Chicago 9/14/09 Gordon Sellers Director, Healthcare & Medical Banking Solutions gordon.sellers@systemware.com
  2. 2. Providers Landscape•  7000+ hospitals, clinics, surgery centers, etc.•  450,000+ physicians in private practice –  Half in practices with more than 5 physicians•  Average 30% first pass denial rate per charge code –  Half due to eligibility issues•  Average administrative cost per submitted claim –  $10 to $12•  Average total administrative cost per secondary claim –  $8 to $10•  Administrative cost for appealed claims –  Can surpass $60 Source: Healthcare Financial Management Association
  3. 3. Why Medical Banking•  Currently banks provide: –  lockbox services such as deposit of payments –  imaging of checks –  imaging of paper EOB (some)•  What banks could provide: –  Data conversion •  of paper EOB’s into EDI 835 files for posting to Provider systems –  Balancing •  of claimed amount with paid amount minus any adjustments –  Process automation •  to reduce error rates and processing cost for Providers –  Visibility •  into the relationships between claims, payments and deposits•  Transactional discipline
  4. 4. Medical Banking
  5. 5. Extended HC Lockbox•  Medical Banking Application –  Capture & indexing of EDI 837 files –  Converts paper EOB’s into EDI 835 files –  Capture & indexing of EDI 835 files –  Automatic matching between EDI 835 files & EDI 837 files at the claim and/or service line level –  Output of targeted file for upload into PMS at Provider –  Secondary / Tertiary claim preparation & submission –  Exception Management workflow queues –  Reporting•  Bank Administration Portal –  Set up & Administration of Providers –  Transaction Billing Report
  6. 6. Online Providers Experience•  Provider Portal (Bank Branding) –  Manage processing exceptions •  837 /835 matching •  Secondary match to primary EOB image •  Secondary match to 835 –  Download posting file –  Research denials for resubmission or secondary –  Dashboards and report generation
  7. 7. Copyright © 2009 Systemware, Inc. 13
  8. 8. Medical Banking•  What banks SHOULD provide: –  Data conversion •  of paper EOB’s into EDI 835 files for posting to Provider systems –  Balancing •  of claimed amount with paid amount minus any adjustments –  Process automation •  to reduce error rates and processing cost for Providers –  Visibility •  into the relationships between claims, payments and deposits –  Transactional discipline •  banks have are good at this healthcare (providers) are not

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