6 Hidden Gems From Medical Billing Experts Using PrognoCIS

November 7th, 2016 - By Kevin V. Nguyen

From payers to patients, everyone wants a smooth claims process – every extra hurdle is time and resources wasted. PrognoCIS practice management software is integrated with the clearinghouse TriZetto to provide features that make claims processing as efficient as possible. Here we go over six gems in PrognoCIS practice management software that medical billing experts will want.

These functions are:

  • Paper Resolve
  • Statements Print in Mail
  • Eligibility Checks
  • Denial Management Screen
  • Auto-Claim Creation
  • Electronic EOBs

1. Paper Resolve, Automatic Paper to Electronic EOB Processing

PrognoCIS works with TriZetto to make it cheaper and easier for providers to send out EOBs. PaperResolve™ automates the posting of paper explanation of benefits (EOB) forms. The system applies a variety of automation technologies to the originating paper; generating EDI 835 ERA (electronic remittance advice) files for electronic posting into patient account systems, saving providers as much as 60 percent in processing costs per claim based on typical client results.

Posting paper payments and EOBs manually can be a slow and tedious process, costing $1.77 more per-transaction than electronic 835 remittance files. This time-consuming process also can result in costly mistakes from incorrectly entered information. With the paperResolve solution, practices can simply scan paper EOBs and the data is automatically and accurately converted into an electronic format, reducing staff time and greatly reducing the possibility of error from manually rekeying data.

2. Online eBills and Print & Mail Statements

With PrognoCIS, billers have the option to send statements to patients online or through the mail with BillFlash. Through PrognoCIS, billers can do a one-time setup to automatic the sending of statements. With online statements, approved bills are delivered same day and payers can easily find current and past bills online, which saves time responding to requests for a “lost bill”. With Print & Mail statements, approved bills are mailed the next business day, and each Mailed bill includes a Payment Coupon and Return Envelope, which increases your cash flow and reduces your processing costs.


3. Eligibility Checks

Insurance eligibility checks and benefit information lead to fewer claims rejections and denials. Having the ability to utilize the most up-to-date information can increase claim acceptance rates and speed up reimbursements. PrognoCIS provides an easy-to-read and comprehensive eligibility request screen. With supported clearinghouses, PrognoCIS displays relevant information based on patient demographics and insurance in relation to eligibility.


4. Denial Management Screen

PrognoCIS integrates with TriZetto to provide an easy to read denial management screen. Clinical staff can view every denied claim through PrognoCIS practice management software, without having to go to the clearinghouse. PrognoCIS integrated electronic health record and practice management software helps you resolve payments quicker.


5. Auto-Claim Creation

PrognoCIS Practice Management Software speeds up the claims process with Auto-Claim Creation. With old-school practices, doctors send superbills, where billers must manually create claims for each charge. With PrognoCIS, medical billers can turn on a function that allows everything the doctor signs to be created into a claim. This function saves tremendous time and resources.

6. Electronic EOBs

Most billers have a tedious and burdensome EOB process: they receive EOBs in mail, download and manually key them,  and then save the EOB in a file. Electronic EOB Creation with Trizetto makes it tremendously easier to process EOBs. PrognoCIS set clients up for electronic remits, which get downloaded into PrognoCIS, pre-fills the data, and that virtual copy is saved with that claim.  Billers can access EOBs through PrognoCIS., without having to go through mail or a clearinghouse.

PrognoCIS Makes Claims Processing Easy

PrognoCIS practice management software is designed to give billers complete control of the financial side of a practice. Each feature is designed to expedite the claims process so payments are made quicker. PrognoCIS is currently rolling out its latest build PrognoCIS Denali, with many new features in its Billing Module. Visit the PrognoCIS Denali Hub or register for our upcoming webinars for more information on what’s new.

Picture Credit: 401k Calculator/Flickr

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