19December 2022During discovery, they studied the process back to the nurse who was providing the shot. From there they traced how the information moved all the way to the biller and eventually the Medicare system. This led to innovation where clinical teams have a tool to deliver information to the biller who can now process hundreds of claims in just a few minutes. "Our customers are now reporting that a process that previously took hours is now done in under 10 minutes" Kimberly Sturm, Director of Customer Experience primeCLAIMS.PrimeCLAIMS also leverages its payer relationships with Medicare, Medicaid, and commercial insurers to run individual and bulk eligibility checks for the entire provision of those services. The application queries the EHR for admission and eligibility information and returns an informed batch response to the user. Users can then investigate patients whose insurance coverage is incorrectly recorded in the EHR to ensure that current and future claims are authorized and billed to the correct payer.Providers are also juggling record numbers of billing audits. To ensure that the revenue recovery teams can stay organized, the revenue recovery feature integrates into Medicare's electronic response system and allows users to collaborate and respond timely. EHR integration and interoperability have been well-received in the post-acute community, as it eliminates redundant steps and duplicate data entries.As primeCLAIMS operates in tune with most EHR/EMR solutions, including PointClickCare and AmericanHealthTech, it is a great fit for the SNF claims processing. In collaboration with PointClickCare, primeCLAIMS was the first clearinghouse to deploy the PointClickCare Marketplace API for 835/837 claim file processing. The integrated feature gives users real-time, two-way data exchange, simplifying claims transmission (to insurers), and the return posting of payment remits. Reviewing claims for payer specific errors is the most critical function of any clearinghouse. PrimeCLAIMS support team reviews payer literature, documentation and any unpaid claims to continuously update the edit programs to maintain accuracy. Instead of putting the burden on edit creation on the customer, primeCLAIMS development teams create and deploy self-generated and customer requested edits quickly. In addition to surfacing errors, the option to edit claims submissions allows SNFs to adjust flagged errors quickly. "The claims submitted through our solutions has high probability of getting approved because our continuously evolving, front end scrubber catches errors before they are submitted. For example, when billers transmit 100 claims, and 1 error is found, the 99 correct claims are allowed to process, and only the 1 errored claim is held back for user correction and resubmission," says Kimberly Sturm, Director of Customer Experience at primeCLAIMS.EzDDE is another leading feature of primeCLAIMS. Our team has worked with billers using the Medicare mainframe DDE system. Billers were sometimes spending in excess of 30 minutes editing a single claim as they deleted lines, added lines and placed modifiers for hundreds of records in a single claim. From that research, EzDDE was born to allow a biller to edit hundreds of lines in 5 clicks and move to the next claim while the proprietary processing engine does the work of the biller in Medicare's system instantaneously. It is an interface where clients can log in to check updates and pay attention to lists that demand attention post-claims submission. EzDDE is a novel take on the existing antiquated mainframe system, enabling users to select and scrutinize all entries in the list. primeCLAIMS fully automates the secondary (co-insurance) claims process. "The secondary claim process is so efficient that sometimes we get paid within the same month we file the primary claim" primeCLAIMS customer. Unlike other clearinghouses that eventually direct billers to print and mail secondary claims PDFs, primeCLAIMS is optimized to directly grab payment remit information and create a secondary claim candidate for biller review and electronic submission to the relevant payer. Operating as the Extension of the SNFs Billing Team Since they are a team who is in tune with their users, team members will go beyond training to even point out and help companies collect their aging. When working on the EHR Account Receivables integration project, they spotted issues in the client's aging Medicare receivables. They then helped Kimberly Sturm, Director of Customer Experience,primeCLAIMS
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