Claims Management

Helping organizations accelerate reimbursement, minimize denials and establish successful core practices over the entire claim cycle via clean claims.

In the midst of changing reimbursement models, health reform, and thinning margins, we make it easier for healthcare organizations to properly – and easily – collect from payers.


SSI provides a 99.25% clean claim rate – among the highest in the industry.

Modules

Billing

Billing

Streamlined claims processing is an essential component to successful revenue cycle management. SSI Billing enables providers to adopt an automated approach to the billing process through the electronic editing, validation and submission of institutional and professional claims. The application’s edits, coupled with extensive payer connections via the SSI clearinghouse, enable organizations to optimize revenue and react appropriately to changes in reimbursement criteria.

SSI Billing technology provides an automated approach to the billing process. The solution translates claim data from the provider’s patient accounting system into the software package where it is validated against multiple levels of edits. It also matches and uploads secondary and tertiary remits, automates user-defined advanced workflow routing and submits claims in both electronic and paper format.

With SSI Billing, your organization can:

  • Gain visibility of the full claim process
  • Rapidly validate and correct claims
  • Streamline claim imports
  • Utilize direct payer connectivity
  • Develop a more seamless workflow
  • Establish an advocate for payer disputes

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Edits

Edits

Following a denial or partially paid claim, providers often fail to pursue revenue because the value of the reimbursement outweighs the resources required to rebill. The Edits package allows providers to protect against missed billing opportunities by running claims through an extensive edit suite to ensure claim compliancy upon initial submission. With SSI Edits, providers can dramatically improve their first-pass rate to receive quick and accurate payer reimbursements.

Given the need for clean claims, especially in today’s complex healthcare landscape, SSI provides a clean claim rate of 99.25% to its users. Edits are provided at the HIPAA, payer and provider levels with custom programming also available.

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Claim Status

Claim Status

Even in today’s world of electronic transactions and real-time information availability, claim confirmation and status updates from payers remain a challenge due to the disparate systems, methods and timing that various payers use. With SSI Claim Status, healthcare organizations can review automated claim status updates to proactively manage, and make real-time corrections in, the Medicare Common Working File (CWF). Claim Status automates claim status retrieval, allows for faster secondary bill payment, and provides recurring error analysis and reporting. The system can also status claims for commercial payers that provide ANSI 276/277 claims status transactions.

SSI Claims Status enables providers to streamline processes, expedite follow-up, and maximize resources with advanced workflow controls and filters. Users can make corrections directly in Medicare’s online system or claims can be re-billed to payers not offering online corrections. Denial, rejection and error information is retrieved electronically on a daily basis, while information including status reason codes, user notes and claim changes can be posted to the hospital information system to create an audit trail.

With SSI Claim Status, your organization can:

  • Automate claim status retrieval
  • Receive immediate notification of Medicare Additional Development Requests (ADRs)
  • Achieve faster secondary bill payment
  • Establish a comprehensive claim change audit trail
  • Obtain the information necessary for recurring error analysis and reporting

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Electronic Remittance Advice

One of the biggest challenges providers face is the ability to manage cash while keeping up with the various payment types. SSI’s Electronic Remittance Advice (ERA) solution manages the retrieval of remittance files and processes an 835 from any payer’s file, allowing providers to electronically auto-post payments.

The application manages ERA payer connections, coordinates payer registration on behalf of the provider, and works with payers for remit file issues. With a streamlined remittance process, providers are able to see payments applied to an invoice or claim, and explore the reasons for denied or partial payments.

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Denial Management

Denial Management

The current healthcare landscape calls for hospital CFOs to revamp the claim denial process, especially as a large portion of payer denials are “appealable.” The more revenue an organization is denied, the less they have to invest in other critical areas. SSI Denial Management gives users the ability to workflow denials and manage claims throughout the appeals/claim process. Effectively managing denials can increase an organization’s net revenue and prevent future denials from occurring.

Product Data Sheet

With SSI Denial Management, providers can easily keep track of denied claims and the impact they have on their organization. The solution enables providers to determine the root cause of denials, view denial trends, and tackle denials with speed and efficiency. Users can establish more accountability and visibility surrounding denial management initiatives.

With SSI Denial Management, your organization can…

  • Automate existing denial management efforts to streamline staff activity
  • Identify and reduce true denials
  • Establish full accountability for every claim and remit
  • Gain visibility into key contributors to positive net revenue
  • Simplify and automate categorization of denials for optimal work queues

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Enterprise Reporting

Enterprise Reporting

With constantly thinning margins, it is important for providers to have the ability to readily access and report on weekly, monthly, and yearly trends within their claims management system. Having a reporting tool allows providers to scale knowledge throughout their organization to prevent bottlenecks and single points of failure.

With SSI’s robust Enterprise Reporting solution, providers are able to quickly measure billed and aged claims and report on recurring errors affecting their claims and biller audit trends. By easily identifying and responding to patterns, providers can strengthen their processes, streamline workflow, and ultimately improve their revenue cycle performance.

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