PrognoCIS Electronic Claims Overview
Electronic Claim Submission with PrognoCIS
PrognoCIS offers providers versatility by supporting both Institutional and Professional Claims for electronic claim submission.
PrognoCIS can process and receive acknowledgments, including EDI 277 and EDI 999. For easy viewing, the software links each acknowledgment to its corresponding claim.
In order to improve the medical billing process, PrognoCIS partners with a variety of other top-rated companies.
These companies include:
- TriZetto provides PrognoCIS clientele with the benefit of electronic prior authorization services.
- DaisyBill improves and simplifies the worker’s compensation billing process.
- Waystar unifies and streamlines healthcare payments.
- Claim.MD allows clients to create electronic claims, which speeds up the billing and payment processes.
- P2P platforms provide patients another method of payment.
According to a study published in the Journal of the American Medical Association (JAMA), Administrative Costs Associated With Physician Billing and Insurance-Related Activities at an Academic Health Care System, the overhead and personnel costs directly associated with insurance activities (including billing) range from $20 for a regular office visit to $215 for an inpatient surgical procedure. These totals represent from 3 to 25 percent of professional revenue. Of course, with scrubbing, providers can eliminate the revenue loss associated with these insurance activities.
Providers can reduce the number of claims the insurance company rejects by employing PrognoCIS’ claim scrubbing service. Claim scrubbing can improve the readability of claims. As a result, by submitting easy to read claims that include all necessary information insurance companies ask fewer questions. Accordingly, claim scrubbing improves cash flow.
PrognoCIS segregates rejected claims, housing them in a bucket, thus, simplifying the process of finding, sorting, correcting and resubmitting rejected claims. In addition, template appeal letters are accessible directly from the claim screen; therefore, faxing is easy. Furthermore, clearinghouse service change how to submit a corrected claim electronically. Providers are allowed to refile their claims without logging into a payer’s website.
Advantages of Electronic Claims
Moving away from the traditional manual processing of paper claims to an electronic claims management preparation process offers a variety of benefits. Using a medical billing service like PrognoCIS for electronic claims processing reduces internal costs and improves office efficiency, thus allowing for more timely payments.
Electronic Claim Submission
Submitting electronic claims using medical billing software benefits providers. Their software provides a securely integrated process for claim submission. PrognoCIS electronic claim submission process saves time and allows providers to receive their payment from insurance companies quicker. Faster payment prevents costly delays and eliminates disruptions in revenue flow.
Claim Processing Reports
PrognoCIS electronic claims medical billing software offers providers numerous reports offering an array of information. Some of these reports include Denial Trends by Provider, Tracking Turnaround Time for Reimbursement. It also includes reports reflecting less payment than the contracted amount by the insurance company.
With PrognoCIS Claim Tracking, providers monitor their claims as they move through the entire process, from submission to payment posting. Additionally, Claim Tracking lets the provider know what steps are being taken to get the claim paid.
More than 2,500 commercial insurance and government payers allow providers to submit claims electronically. By filing claims electronically providers can receive reports detailing the status of each claim.
Eclaims Workflow
The basic procedures for transmitting an electronic claim are easy to learn. Submitting Eclaims online instead of using traditional paper claims allows providers to quickly create and digitally submit error-free claims. Moreover, providers can easily attain patient insurance benefit information and check claim status. Eclaims eliminate the time-consuming process of data entry as well as any follow-up steps that paper claims require. Eclaims processing offers providers a streamlined claims processing workflow to ensure swift payment.
