HealthCareIQ is about Artificial Intelligence… by oas1s

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									                                    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.

								
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