Claim Inspector
Industry experts estimate that an astonishing 30 percent of medical claims are rejected on first submittal. With constantly-changing rules, codes and coverage, practices are hard-pressed to beat the claims-submittal odds. AdvancedMD Claim Inspector can help. A lot. This industry-leading claims scrubber automatically runs more than 3 million edits on each claim for CCI, HIPAA, LCD and carrier-specific requirements before it is submitted. Specific issues are identified and tools provided to quickly produce a clean claim inside billing workflow. As a result, AdvancedMD customers run at a rate of 95 percent or better claim acceptance. Guaranteed!
Achieve 95 Percent First-pass Clean Claims with AdvancedMD Claim Inspector
The AdvancedMD Claim Inspector automatically scrubs each claim and identifies potential rejection errors before claims submission – saving hours of effort on tracking appeals and significant potential lost reimbursement. With a combination of comprehensiveness and effectiveness unique in the industry, Claim Inspector checks more than 3 million edits for CCI, HIPAA, LMRP and carrier-specific exceptions, and returns detailed reporting on identified problem areas so they can be quickly corrected inside the workflow. As a result, clinics using Claim Inspector routinely see their percentage of rejected claims fall – and stay – below 5 percent. That’s an AdvancedMD guarantee.
Always Up-to-Date
Claim Inspector is continuously updated to incorporate the latest edits and changes. Because it is part of the AdvancedMD Web-based hosted software solution, you are guaranteed to always be working with the most up-to-date information available. No software to download, no updates to install, no disks to order. It’s there and current each time you log on.
Detailed Scrubbing, Manageable Work List, Easy Correction
Claim Inspector checks each claim for potential rejection errors in three specific areas.
- Procedure Coding – compliance with CCI policies, gender and age restrictions, and medical necessity requirements using CPT/ICD9 crosswalk data
- Diagnosis Coding – validating primary diagnoses and proper levels of specificity, as well as the inclusion of any required accompanying diagnoses
- Payer-specific Rules – local and national coverage determination policies for all major government- and commercial payers
Claims with potential problems are included in an easy-to-manage list and linked to detailed screens describing the error, related procedure codes and other vital visit information, together with carrier-specific information and contacts. Problem claims can be quickly and easily corrected without disrupting billing workflow, speeding submission and dramatically reducing the rejected claim banter that creates a drag on productivity and reimbursement.
