Timely submission of claims with a level of integrity is one of the major challenges that we overcome for the organisation
Batching of finalised claims subjected to each payer’s claim submission protocol.
Generation of statements for each batch & summary of claiming period.
Electronic claims to be processed via the HIS, & paper claims are scanned & archived.
Delivery of claims to payers through officially contracted channels.
Obtaining confirmation of delivery from the payer’s side.
Delivery dates logged & synced with denial management to follow for denial alerts.
Check on timelines of submission, resubmission, reconciliations & payment settlement.
Ensure that Minimal Data Set & regulatory forms are fulfilled & are supported by HIS
Establish optimal workflows that shall start at the time of closing a (OP/IP)
Maximise utilisation of HIS capabilities for claim scrubbing & Nphies integration
Set validations within claim processing for clinical documentation, financial auditing etc.
Judicial deployment of technology wherever possible to lower the Turn around time.
Automated processed to ensure that timelines are met at all levels.
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