Claims Processing Module
The Claims Processing (Billing) Module
streamlines data entry and research methods and provides
efficient reporting tools. In addition, this module is flexibly
designed for multiple types of billing.
Authorizations: Authorizations are based
on benefit package or procedure code:
-
Benefit packet
authorizations are based on groups of procedure codes,
diagnosis and facility.
-
Procedure code
authorizations are based on specific procedure codes,
diagnosis and facilities.
Service Billing: Service Billing
is based on service type, allowing for generic service entry.
The service then creates the procedure code based on client
and staff specific information.
Rate Identification: There are five
levels of rate identification utilized in the ClaimTrak
system:
-
Usual and Customary
on Procedure Code
-
Staff Level
for Procedure Code
-
Guarantor Default
Rate
-
Staff level
for Guarantor
-
Contracted Authorization
rate
Billing Matrix: The Billing Matrix allows
for the same service to generate different procedure codes
for guarantor and staff levels. Claims can be created by
direct entry into a charge batch or using the scheduling
module to generate show and no-show claims. Edits are in
place at all levels of processing. These edits are based
on industry standards, guarantor specific rules and ClaimTrak
proprietary information.
Billing Generation: The ClaimTrak
system has the ability to produce billing in various methods
including:
Additionally, the ClaimTrak system
has electronic EOB (Explanation of Benefits) capability.
This capability allows a provider/physician to directly
import claims’ EOB or remittance and apply payments.
Additionally, the ClaimTrak system has the capability
to track claims based on client, staff, location, guarantor
and fund source.
User defined history codes have been developed
to track claims history items such as payments, denials,
submissions and resubmits. In addition, multiple shortcuts
and reports have been incorporated to ease claims research.
