THE INTELLIGENCE THAT DRIVES HEALTH CARE providers HealthCareIQ is about Artificial Intelligence… HCIQ’s dynamic Rules-Based Engine (RBE) tracks, updates and maintains a comprehensive knowledge-base specific to the health industry on both the local and national level. The RBE applies a series of sophisticated, clinical and financial based edits analyzing the following relationships: • insurance company • employer sponsored benefit plan provisions-exclusions-limitations • coverage issue • financial outcomes, i.e. reimbursements • clinical policy • utilization guidelines • coding edits • line-item information contained in insurance claim or remittance statement All benefit plan provisions, including clinical and financial rules are directly aligned with the following edit criteria: • single medical bill • single patient • provider specialty • place of service • same date of service HCIQ’s Artificial Intelligence maps directly to the clinical, financial and business rules that impact insurance companies, managed care organizations, health care community and employers. The intelligence is our Rules-Based Engine identifies and automatically updates the edit criterion used to establish public and private sector benefit plan adjudication rules. THE INTELLIGENCE THAT DRIVES HEALTH CARE Impact Analysis providers A snapshot of where your business is today. HealthCareIQ reviews your EOB’s to provide a comprehensive Impact Analysis. HCIQ’s Artificial Intelligence validates the appropriateness of reimbursements, denials and delays in compensation and delivers a detailed report. 1. Data Collection Options A. HCIQ loans client a B. HCIQ scans client’s EOB’s C. EOB’s are mailed or scanner for use on-site utilizing our Scan-A-Van picked up by HCIQ for at client’s office scanning at our facilities 2. Data Entry – 48 Hour Turnaround A. Scanned EOB’s are B. Data is validated against mapped through HCIQ’s Payer Profiles to verify Rules-Based-Engine integrity of data 3. Impact Analysis Processing – 5 Business Days A. Results are viewable B. Your Impact Analysis via HCIQ’s secure Internet is password protected based Message Center utilizing your Tax ID# Value Proposition Each Impact Analysis provides Each Impact Analysis includes: valuable information: • Performance Evaluation – Administrative and • Invalid Denials Outsource Performance • Avoidable Denials • Recommendations • Underpayments • Holds Payers and Vendors Accountable • Reasonable and Customary Charges • HCIQ’s Net Impact to the Practice • Operational Savings (Revenue Improvement Ranges From 7% – 28% • Missed Revenue Opportunities and Positive Edits Based on Specialty and Practice) • Collectible Fees THE INTELLIGENCE THAT DRIVES HEALTH CARE providers Impact Analysis Sample Report THE INTELLIGENCE THAT DRIVES HEALTH CARE providers Impact Analysis Sample Summary THE INTELLIGENCE THAT DRIVES HEALTH CARE providers Pre-Adjudication Identifies avoidable denials prior to submission – reducing errors and time for payment. HealthCareIQ’s unique web-based pre-adjudication system increases profitability by identifying avoidable denials and recommending solutions before claims are submitted to payers. HCIQ’s All Payer solution utilizes a Rules Based Engine and a proprietary database to target potential denials or delays in payment with payer specific insight on how to minimize uncompensated treatments. • We import your claims – uploaded to our secure message center as attachments • Avoidable denials and solutions are reported to you via the web • Reviewed and corrected claims are submitted electronically to payers Pre-Adjudication Details The pre-adjudication process will review and validate: • Policies Respecting the Reimbursements of Supplies • Policies Respecting Multiple Procedures Performed on the Same Date of Service • Definitions of “Medical Necessity” and “Medical Necessary” • Clinical Policy • Fee Schedule Information • Claim Bundling Logic • Relationship Among Billing Codes • CPT-HCPCS/ICD-9 • Crosswalk Table • Miscoding Edits • Diagnosis Edit Tables • Modifier Edit Tales • HCPCS Modifier Table • Procedure Edit Table • Multiple Procedural Edits • Place of Service Edits • No Surgical Assistant Required Edits • Prior Approval Edit • Maximum Frequency Per Diem Edits • Global Period Edits • Unbundle Edits • Rebundle Edits Continues on next page THE INTELLIGENCE THAT DRIVES HEALTH CARE Pre-Adjudication providers Continued from previous page Claims Electronic claims submission can by from Superbills, encounter forms, charge slips, OCR file 1. Data Collection Options A. HCIQ loans client a B. HCIQ scans client’s EOB’s C. EOB’s are mailed or scanner for use on-site utilizing our Scan-A-Van picked up by HCIQ for at client’s office scanning at our facilities 2. Legacy File – Your Existing Practice Management System (See Attached List) 0010011001101 1010010110011 1001000010111 1111000111001 A. Print Image File 1010101010101 B. Electronic File 1001010110110 1011011011010 1110001111101 1011011011101 C. Test file is submitted to HCIQ’s Rules Based Engine to validate file and format 3. Pre-Adjudication A. HCIQ’s system consolidates B. Potential denials, suspension messages for each claim and of claims and missed revenue sorts status by patient, payer, opportunities identified plan type, reimbursements (See Attached List) 4. Client Review 0010011001101 1010010110011 A. Results posted for client 1001000010111 B. HCIQ forwards messages in an review on HCIQ’s secure 1111000111001 XML file format back to client OR 1010101010101 message center 1001010110110 1011011011010 1110001111101 Failed Claims: Put on HOLD with payer/ 1011011011101 benefit plan specific reasons for HOLD status and recommended solutions to Approved Claims: Identified and viewable resolve problem. Results viewable on on message center or in XML file format. message center or in XML file format. 5. HCIQ Claims Submission A. HCIQ Clearinghouse Partnership Program: HCIQ will submit pre-adjudicated claims to: Web MD, Proxymed, TMI, Medicare, Medicaid, Blue Cross and others 0010011001101 B. HCIQ provides electronic claim 1010010110011 submission, real-time and batch 1001000010111 C. Non-electronic claims are printed claim status, real-time and batch 1111000111001 and forwarded to the designated 1010101010101 eligibility verification, ERN’s 1001010110110 insurance company. (Additional (electronic EOB’s) (Availability 1011011011010 per claim charge for this service) varies by insurance company.) 1110001111101 1011011011101 6. Client Claims Submission A. Clients can opt to receive claim status via the message center or in XML file format and submit their own claims. THE INTELLIGENCE THAT DRIVES HEALTH CARE providers HCIQ Interface: Practice System List Partial List of Practice Systems A.D.S. ELCOMP MEDFORMATION SOLUTIONS ABS eMD’s (Topsuite) MEDIC Practice Pro ACCU STAR EON MEDICAL MANAGER PRACTICE STAR AccuMedic FOXMED Medinfomatix PREMIS ALCON / IVY FUTUREMED MEDISENSE PROMED Antrim GAZELLE MEDISOFT Protocal ASPC GREY CAT MediSolutions ProviderLink Cactus GSR MEDPAC PSI CBSI HANDYWORKS MEDWARE PSYCH BILL SYSTEM CERNER HBOC MGT PLUS PTOS Chiro 7000 HBOC/POM MICROEDGE QUALITY DATA ChiroPulse Healthcare Systems Millbrook Paradiam C Radministration CHIROSOFT HEALTHSOUTH PAS Minerva RADNET COMP INNOVATIONS Hippocrates III MMS RADVIEW COMPU SERV HIS MONITRX RHI MED COMPULINK IBM DOMS 2 PLUS Mr. BILL RLI COMPUMED ICIS MS GROUP RPM COMPUSENSE ICS MultiData Systems RX COMPUTER CLINIC IDEAL Multitech SATORI Control-o-fax IDX OFFICEMATE SELF Custom Made INCEPTION Omni Medical SENEYET DALCON INFO CURE Systems SHRINK Data Medic INFOSYS OMS/SILENT SIS DATAEASE JESS MED SYS PARTNER SMART SYSTEM DB CONSULT JQ4Win P-Lab SMS DBS K&K PARKER SOFT AID DNA Datasystem LOGICAL PATIENT PAS-3 SPECTRA MED/PP DOCPRO LYTEC Pathways PMS MANAGER DR CEO Lytec 2000 PATTON DATA SSI DR SOFTWARE Lytec 98 PCCS PLUS SurgeOn DUTCHMAN MAI BASIC PCN TEMPLE SOFTWARE MaximEyes PDMG THERAPIST HELPER DYNASTORE MBA Perfect Care Thomas / Genius Eagle MD BASE PHOENIX CHIRO Turbo PT Easy Bill MD Versaform PHYSICIANS BILLING VERSYS EASY START MED 1 (Med First) PINPOINT (Zoll) VISIONARY OFFICE EASYPOWER MEDAPHIS PMS WALLABY EBS MEDCARE Polci Adv. Zygote ECHO MedComp POTOMAC ECLIPSE/MPN MEDFAX PRAC BUS. THE INTELLIGENCE THAT DRIVES HEALTH CARE Denial Management providers Re-adjudicates EOB’s to identify errors and missed revenue opportunities. HCIQ’s intelligent, effective and pre-emptive denial management system helps you recoup losses and automatically avoid the same denials in the future. • We re-adjudicate EOB’s • We convert paper EOB’s into electronic formats to readjudicate detail lines • We review claim history files and system databases to identify inappropriate adjustments, write-offs, underpayments and missed revenue opportunities, during readjudication 1. Data Collection Options A. HCIQ loans client a B. HCIQ scans client’s EOB’s C. EOB’s are mailed or scanner for use on-site utilizing our Scan-A-Van picked up by HCIQ for at client’s office scanning at our facilities 2. Legacy File – Your Existing Practice Management System (See Attached List) 0010011001101 1010010110011 1001000010111 1111000111001 A. Print Image File 1010101010101 B. Electronic File 1001010110110 1011011011010 1110001111101 1011011011101 C. Test file is submitted to HCIQ’s Rules Based Engine to validate file and format 3. Denial Management Report A. Results posted on secure site for client review Continues on next page THE INTELLIGENCE THAT DRIVES HEALTH CARE providers Denial Management Continued from previous page Value Proposition Denial Management Reports Identify: Provides: • Inappropriate Adjustments • Auto-correction of coding relationships • Avoidable Denials • Distribution of denied procedures to • Collectible Dollars appropriate collectors • Standard EOB Paper/Electronic Remark • Performance Measurement Codes • Financial Analysis and Business Reports • Fixed Cost Analysis • Performance Evaluation per Collector Re-Adjudication Details The re-adjudication process will review and validate: • Re-Adjudication of Benefit Provisions • Miscoding Edits According to Patient Contracts • Diagnosis Edit Tables • Policies Respecting the Reimbursements of • Modifier Edit Tales Supplies • HCPCS Modifier Table • Policies Respecting Multiple Procedures • Procedure Edit Table Performed on the Same Date of Service • Multiple Procedural Edits • Definitions of “Medical Necessity” and • Place of Service Edits “Medical Necessary” • No Surgical Assistant Required Edits • Clinical Policy • Prior Approval Edit • Fee Schedule Information • Maximum Frequency Per Diem Edits • Claim Bundling Logic • Global Period Edits • Relationship Among Billing Codes • Unbundle Edits • CPT-HCPCS/ICD-9 • Rebundle Edits • Crosswalk Table Options HCIQ provides additional options including: • Auto Posting • EOB Archiving • EOB Imaging and Retrieval THE INTELLIGENCE THAT DRIVES HEALTH CARE providers Practice Management HealthCareIQ has developed Smart Practice to assist clients who would like to incorporate an intelligent practice management system. Smart Practice is available as a Basic or Platinum program. Smart Practice Basic (Free) • Interactive Pre-Adjudication System • Patient Demographics • Insurance Information • Scheduler • Claim Detail Information • Authorizations • Facility Information • Financials Smart Practice Platinum (Fee Based) Includes Basic features plus: • Web Based Point and Click Encounter Forms • Viewable EOB’s • Viewable Encounter Forms • Eligibility, Authorization and Referral Requirements • Auto-Posting: Electronic and Paper EOB’s • Viewable and Retrievable Medical Transcriptions and EMRs THE INTELLIGENCE THAT DRIVES HEALTH CARE providers Additional Services Performance Enhancement Technologies HealthCareIQ’s PET’s will scan paper EOB’s. Its Optical Character Recognition Software maps into the Rules-Based Engine with an option to: • Auto-post EOB details into existing practice management systems. • Provide customized in-bound files to automate cash posting with claim and EOB details. Outsourcing Services To address the continued increases in fixed costs, hardware and labor, HealthCareIQ offers a variety of outsourcing solutions. • Billing services • Collection services • Technical health information services • Programming • Website development • Hosting • Vendor evaluation services • Consultative Services • Billing company audit and review services • Practice management evaluation • Compliance program evaluation • Insurance company audits • Managed care contract review services • Contract negotiations • Medical documentation audit and review services • Billing and collection assessment and recommendations • Site evaluation – information and workflow assessments Support • HealthCareIQ’s skilled employees are available to schedule internet based live meetings with health care providers, administrators and billing staff. • Our current technologies provide a suite of features that enable us to share information online to prospects and clients in real-time. • Training, technical support, and educational meetings are available via a standard Web browser with very high resolution and full screen viewing capability. • Live demos or training include a review of documentation, applications, and HCIQ’s AI impact reports that are targeted to improve clinical and financial outcomes and individual performance at the medical facility.
Pages to are hidden for
"HealthCareIQ is about Artificial Intelligence…"Please download to view full document