Custom Design
This is not a one-size-fits-all organizational directory. This solution was designed specifically to house practices and providers.
Bulk Import
No manual entry needed! Import all providers and fee schedules from Excel, CSV, or API of your choosing.
Intelligent Matching
Eliminate manual work by defining custom rules to match billing, pay-to, rendering providers, and even custom fee schedules.
Contract Management
Our pricing tools are built in such a way to prevent repeating of the same fee schedule data over and over. Carve-out codes as needed and leave the main fee schedule untouched.
Provider Data Management
Housing Provider Data
Our suite of PDM tools was built from the ground up specifically for housing practices and providers. Data is setup in a tree like structure with markets at the top, then practices, and then individual providers. This setup ensures the billing, pay-to, and rending providers are properly recognized when processing claims.
Custom Contract Management
We create a well-defined set of rules for claims pricing and administration fees. These rules are not limited to static fee schedules. We have the capability to expand the schedule by effective and term dates, percentages, and other custom rules without the need to duplicate large fee tables for any special cases.
The contracts and fee schedules are easily managed using online tools that are able to address these common issues without making a mess of your data. The editors typically support custom contracts for fee-for-service schedules, risk based contracts, bulk import and other special case rules.
Our systems are capable of pricing claims based on DOS, strict contract amounts, billed amounts, or percentages of these amounts. We also have rules designed to handle risk or pass-through claims that need no pricing other than the ability to track what is owed in COB or patient responsibility balances.
Manage Large Datasets
Storing and tracking provider data can get complicated fast. It's easy to be overwhelmed by how much data needs to be stored and saved over the years. Keep track of this data, including contract and fee schedules with quick search capabilities, effective and term dates on all items, and fall-through logic for fee schedules.
For example, lots of contracts are based on a percentage of Medicare. Import one contract that represents the Medicare price -- and update it yearly/quarterly as needed. All other contracts can be based on this original fee schedule and combined with certain percentage and date of service, the data does not need to be duplicated.
Import data for both providers and contracts using our bulk import tools. These tools support a number of formats including CSV, Excel, and outside systems, such as V12.
Pricing Methodologies
Our Claims-Flow software supports a number of pricing methodologies that we've needed to support over time. These are, but not limited to:
- Fee For Service - Fixed price (or percentage of that price) based on service date, HCPCS, and contract.
- Allowable Mark Up - A percentage of the payor's allowable. This can be above or below 100%.
- Capitated Payment - Cap payments are assumed to not have cash amounts tied to them. This can be configured as needed.
- Pass Thru Payment - No change to the payment