Claim Inspector

With constantly-changing rules, codes and coverage, practices are hard-pressed to beat the claims-submittal odds. Industry experts_† estimate that 30 percent of medical claims are rejected on first submittal. AdvancedMD Claim Inspector can help. Our software automatically runs more than 3.5 million edits on each claim for CCI, HIPAA, LCD and carrier-specific requirements before the claim is submitted. Specific issues are identified and tools provided to quickly produce a clean claim inside the medical claims billing workflow. As a result, AdvancedMD customers run at a rate of 95 percent or better medical claim acceptance. Guaranteed!

Achieve 95 Percent First-pass Clean Claims with AdvancedMD Medical Billing Claim Inspector

The AdvancedMD Medical Claim Inspector automatically scrubs each claim and identifies potential rejection errors before medical claims billing 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 medical claims billing workflow. As a result, clinics using Claim Inspector routinely see their percentage of rejected medical 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 in medical claims billing. 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 Medical Claims Billing 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 for medical claims

Claims with potential problems in your medical claims billing workflow 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 medical claims can be quickly and easily corrected without disrupting billing workflow, speeding submission and dramatically reducing the rejected medical claim billing banter that creates a drag on productivity and reimbursement.

_{†Medical Group Management Association (MGMA) The Physician Billing Process: 12 Potholes to Avoid in the Road to Getting Paid, 1st Edition}