Primary Claims Filing

Automating Primary Claims Filing within an EHR offers several benefits for healthcare providers. By automating this process, providers can improve the accuracy and efficiency of claims submissions, minimizing the likelihood of claim rejections and payment delays. Automating claims filing can also help healthcare organizations optimize their revenue cycle by streamlining the claims submission process and reducing administrative burdens. Moreover, automated systems can detect and flag potential issues with claims before submission, decreasing the risk of rejections and delays. Automating Primary Claims Filing can ultimately lead to better financial outcomes, reduced administrative costs, and improved patient care for healthcare organizations.

What Are the Top 5 Industries That Benefit from Primary Claims Automation? Insurance, Hospitals and Clinics, Medical Billing and Coding Services, Government Health Agencies, and Pharmaceutical Companies.

It's important to note that the exact steps a bot might take can vary depending on the specific electronic prescribing and medication management software and the healthcare provider's workflows. Additionally, while the bot can perform many of the medication management tasks, some actions may require human intervention and oversight, especially in complex cases.

Function:

Accounts Receivable

Revenue Cycle Management

Claims Filing

Steps

Data Extraction: The bot may extract relevant data from the EHR system, including patient information, diagnosis codes, procedure codes, and insurance information.
Eligibility Verification: The bot may verify that the patient is eligible for the services being provided and that the services are covered under their insurance plan.
Claims Creation: The bot may create a claim form with the relevant codes and information required for submission to the insurance company.
Claims Submission: The bot may electronically submit the claim to the relevant insurance company, which can improve speed and accuracy.
Claims Tracking: The bot may track the status of the claim submission, including monitoring for any issues or rejections.
Payment Processing: Once the claim is approved, the bot may generate a payment request to the insurance carrier and record the payment in the EHR system.
Denial Handling: If the claim is denied, the bot may generate an appeal request and resubmit the claim or take other appropriate actions to address the denial.
Reporting: The bot may generate reports on claims processing metrics, such as the number of claims submitted, the percentage of claims approved or denied, and the average payment time. These reports can help healthcare providers identify areas for improvement and optimize their claims processing workflows.

Popular Applications

Our services are not limited to these applications. This automation is available for any cloud based application.