Jonathan Duvall, Sr. Director of Product Management, primeCLAIMS and Kimberly Sturm, Director of Customer Experience, primeCLAIMS
Proclaim Partners, has released its latest iteration of primeCLAIMS to bring groundbreaking innovation to post acute claims processing. As an all-payer clearinghouse hailed from the post-acute community, primeCLAIMS brings seasoned expertise to bridge the gaps in the SNF niche. Their industry know-how and a deep understanding of t intricacies of claims-handling workflows were instrumental in continuing to advance primeCLAIMS, a highly intuitive platform that allows billers to do more with less effort. The purpose-built software taps into the primeCLAIMS product team’s firsthand experience handling institutional and professional claims to bring transparency into every avenue of claims processing and streamline workflows.
“Our goal is to provide software that goes beyond processing claims and integrates into an organization’s revenue cycle workflow. By studying workflow, primeCLAIMS delivers an intuitive experience to get companies paid every dollar for every day of patient care,” says Jonathan Duvall, Sr. Director of Product Management, primeCLAIMS.
Single System, Fully Featured
PrimeCLAIMS fully automates the claims handling processes by bringing everything online to facilitate seamless electronic claims submission. primeCLAIMS workflows empower billers to collect cash faster and reduce days sales outstanding (DSO) with fewer resources. The latest innovation integrates claim data from primeCLAIMS, with aging data from the electronic health record (EHR). This new marriage of information brings visibility to the true status of an aging balance. Billers and managers now have a clear picture of how all aging balances are all in process to get paid at the expected rate.
Other innovations include month-over-month billing comparisons through a side-by-side, claim-to-claim comparison to uncover all relevant discrepancies, flu and mass immunization roster billing, and an EzDDE Medicare DDE emulator. The process to develop flu roster billing is a great example of how the product team at primeCLAIMS works. During 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.
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 selfgenerated 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 (coinsurance) 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.
Our goal was always to provide software that goes beyond processing claims and ensures that our clients are getting every dollar for the services offered
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 the client understand the deficiencies in their aging reports. PrimeCLAIMS managers then worked with the customers management team to run special training session for their billers to address those types of claims better. The proactive approach was instrumental in turning aging into cash. This instance exemplifies how primeCLAIMS will go the extra mile to help their clients.
A core differentiator that sets primeCLAIMS a notch above its competition is their quick response to resolving clients’ queries. Their sameday, informed, response allows them to foster long-term relationships with their client base. primeCLAIMS affirms all its success to a team of post-acute industry veterans and technology experts. Some of their long-standing clients have worked with the company for over a decade. This is a testament to how ProClaim Partners functions as an extension of the billing teams and consistently delivers best-inclass solutions that resonate with the post-acute community.
ProClaim Partners is a staunch advocate of molding technology solutions to suit user purpose without requiring significant training time. Enrollment is simplified with a facility and payer based tracking tool and directs the system administrator on exactly what steps need to be completed for enrollment. Access is tailored by role and facility to focus the user’s daily work. The intuitive home screen dashboard and user-centric mindset allows users to navigate claims transmission and submission processes effortlessly.
In a world where most healthcare innovation focuses on patient care, it is also exciting to find forward thinking products like primeCLAIMS that develop features to intuitively enhance the back end of the care process and augment the revenue cycle team’s workflow. PrimeCLAIMS mission is clear, it’s about a care organization efficiently getting paid for the care delivered by the doctors, nurses, aides, culinary teams, housekeeping and administration. Cash powers the care team to do the important medical work; and primeCLAIMS is a clearinghouse focused on how fast they can help organizations convert revenue and aging to cash, not just moving claims from one place to another.
