Claims Processing & Submission

Timely submission of claims with a level of integrity is one of the major challenges that we overcome for the organisation

Claims Processing Key Factors

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.

The Process We Follow

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.

Ready to talk?

Are you planning to streamline your hospital/clinic processes with the help of automation and latest healthcare software systems? Just provide us some information about yourself and we will get in touch with you.