Customized, postable healthcare remittance data translated from all forms and sources
ImageScan Inc., a U.S.-based, leading transaction software solutions provider announced today the release of the Comprise module for RevenueExpress, ImageScan’s outstanding software offering for medical payment data extraction. RevenueExpress offers the utmost efficiency to healthcare providers and business process outsourcers who need to convert EOB-based denial information and payment data into business-usable information. Comprise augments these base capabilities by incorporating all electronic files into the process.
Comprise accepts any and all 835 files or ERAs in any format and then reformulates the data into a fully customized, “postable” 835, using business rules already established within RevenueExpress. Comprise accepts the “many input” files and makes it possible to easily implement a completely customized “single output” data layout, including all segments, fields, and value locations, as needed by the provider organization. Comprise delivers immediate value by virtually eliminating the time lag and expense associated with onboarding a new payer format to receive electronic payments, saving everyone concerned programming costs and significant lost time.
Comprise features a unique crosswalk utility that automatically translates all custom payer remark and denial codes, as well as HIPAA Claim Adjustment Reason Codes (CARC) and Remittance Advice Reason Codes (RARC), to the specific lexicon of the healthcare provider. The system fully enables even conditional crosswalking, field configurable as needed, where specific remark and denial code values can be translated based on provider-specific business rules. For the very first time, medical provider organizations can now analyze all payment data, whether paper-based or electronic, in real-time. Down-the-line processes such as rebilling and secondary billing now will receive all payment data in customized formats, complete and accurate.
“Healthcare providers and their contracted BPOs must accept electronic remittance advice (ERA) transactions to meet deadlines imposed by PPACA, but their systems may not be equipped to accept electronic files from some payers without overcoming time-consuming hurdles at major cost,” says Chet Guardino, President and CEO of HTI Healthcare. “Comprise allows patient accounting systems and denial management systems to automatically accept and adapt ERAs, 835 formats and even electronic print streams from whatever source in the proper formats, as defined by the receiving provider, with flexibility and accuracy.”