Elevate your claims management process with
extensive edits and an industry-leading
clean claim rate of 99.25%

SSI Claims Management Benefits

With SSI Claims Management, your organization can…

  • Track and monitor the complete transmission process
  • Customize revenue cycle data flow
  • Visualize productivity and claim submission
  • Establish an advocate for payer disputes
  • Increase staff efficiency through automation of routine tasks
  • Leverage edit intelligence to direct staff focus to the claims that require the most attention
  • Shorten your organization’s payment cycles to achieve more accurate revenue forecasts

SSI Claims Management Products

SSI Claims Director

To succeed in the current market, providers require access to technology that allows for accurate claim submission and rapid reimbursement. SSI Claims Director streamlines organizations’ billing practices by guiding users through the electronic claim submission and reconciliation process from beginning to end. With a comprehensive mix of edits at the industry, payer and provider levels, the solution enables organizations to make the most of their reimbursement efforts. Additionally, as payers change or modify their reimbursement criteria for services, the system actively monitors and incorporates these changes and requirements. An integrated, intuitive system, SSI Claims Director allows organizations to take a proactive approach to the claim cycle, maximizing payer payments and minimizing denied claims.

Product Data Sheet

With SSI Claims Director, your organization can:

  • Claims Management Workflow
    Accelerate reimbursement with a winning combination of technology and support. A best in class, HFMA peer-reviewed solution, SSI Claims Management Workflow offers providers an automated approach to the billing process by facilitating the electronic editing, validation transmission of institutional and professional claims.
  • Billing Edits
    Protect against missed billing opportunities by running claims through an extensive edit suite, maintained by SSI, to ensure claim compliance upon initial submission. Dramatically improve your first-pass rate to receive quick and accurate payer reimbursements.
  • Claims Submission and Exception Processing
    With over 900 direct payer connections and over 100,000 discrete edits, more than one-third of the U.S. hospital market relies on the SSI EDI Clearinghouse. Submit HIPAA transactions in real-time or batch to commercial and government payers, including Medicare and Medicaid; check eligibility and benefits (270/271), file medical claims (837P and I), receive electronic remittance (835), and review claim status (276/277), and submit authorizations and referrals (278).
  • Claims Status
    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.
  • Remittance Management
    See payments applied to an invoice or claim, and explore the reasons for denied or partial payments. SSI Remittance Management 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.
  • Denial Management
    Determine the root cause of denials, view denial trends, and tackle denials with speed and efficiency. Gives users the ability to workflow denials and manage claims throughout the appeals/claim process.
  • Enterprise Reporting and Dashboards
    Quickly measure billed and aged claims and report on recurring errors affecting your 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.

SSI Claims Director: Epic

The SSI Claims Director: Epic solutions is tightly integrated with the Epic billing system…. With SSI Claims Director: Epic, clients experience improved validation rates through integrated and automated reporting feeds into their Epic system, which includes the number, and type, of recurring errors and the Epic Claim Status Codes. Within these automated file feeds, SSI can load payer status messages (277) directly into Epic as a pipe delimited Epic CRD file. Using just one loader, both validation information and payer status files are returned and matched according to Epic’s specifications. This integration enables a smooth workflow process for users to maintain all work within the Epic host system.

SSI Claims Director: Cerner

Sold directly through Cerner, SSI Claims Director: Cerner includes the functionality of SSI Claims Director, tailored to the specific needs of Cerner users. Access content via Millennium interfaces, including bill date, payer responses, and remittance data. See SSI Claims Director description for details. SSI Edits are integrated within the Millennium workflow.

Additional Functionality

Correspondence Conversion

Paper-based correspondence is still a major issue for providers. SSI Correspondence Conversion enables organizations to extract index data from scanned images of paper-based correspondence letters typically mailed from payers to healthcare providers. Types of paper correspondence include, but are not limited to, insurance payment denial explanations, additional documentation requests, authorization rejections, patient medical necessity determinations, bill under review and legal correspondence. A text file or “zero dollar” EDI 835 is created form the extracted information to automate importing into other systems. Extracted fields include claim ID, insurance company name, correspondence reason, letter date and patient account number. The information is archived and fully searchable by indexes.

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EOB Conversion

With payers still holding on to paper-based systems, providers need a way to easily extract that data into their systems; the cost of dealing with both paper-based and electronic documents is just too high. SSI EOB Conversion extracts data from scanned images or PDF documents created from paper-based Explanation of Benefits (EOB) or Explanation of Payments (EOP) to deliver an EDI 835 Electronic Remittance Advice (ERA) files that are ready for cash posting in practice management or hospital information systems.

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Claims Status Plus

SSI Claim Status Plus automates the follow-up process for commercial payers and Medicaid, which accelerates a provider’s timeline for receiving payment, while reducing the cost-to-collect. Automated bot technology retrieves claim status data from payer websites and generates a list of accounts with “approved” and “denied” status, as well as the denied reason codes. These bot-generated statuses reduce the manual effort associated with logging into each payer website, searching for the key information and pasting the data into other systems for follow up. Using bot-response information, providers can then automate claim status activities based on response type and hone in on the items that truly require intervention.

With SSI Claim Status Plus, your organization can…

  • Lower A/R days resulting from denied or unpaid claims not being worked in time
  • Eliminate inefficiencies of manual status searches
  • Reduce FTEs or third party vendors dedicated to claims follow-up activities
  • Alleviate non-productive touches on claims that pay; automate and accelerate follow-up on claims requiring resolution
  • Create a feedback loop for rejection denial avoidance
  • Gather more actionable detail than a standard 277 transaction
  • Easily manage login credentials with automated credential features

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SSI Attachments can be used by providers to send electronic attachments to payers for claims requiring additional documentation, which includes Workers’ Compensation claims and the CMS Electronic Submission of Medical Documentation (esMD). With the use of a secure Web portal, Attachment Processing allows providers to completely automate the delivery of most any type of attachment. As a result, organizations can expedite payment and unify their workflow across a distributed response team.

With SSI Attachments, your organization can…

  • Expedite payment – get paid within an average of 15 days
  • Receive a near-instant return on investment by eliminating the need to mail paper claims or attachments and reducing corresponding shipping costs
  • Seamlessly track the status of claims and attachments via 277 information received back into SSI Billing and the attachment portal
  • Transmit ADR and attachments back to the contractor electronically using SSI’s esMD Gateway
  • Reduce administrative costs for your facility
  • Quickly attach images by scanning, importing or utilizing direct print capabilities

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Pre-Billing Eligibility

Incorporating Pre-Billing Eligibility into the claim scrubbing process enables providers to reduce denials and unnecessary write-offs due to coordination of benefit discrepancies. Given Medicare’s restrictions on reimbursement, Pre-Billing Eligibility allows providers to confirm they are routing claims appropriately for patients with HMO plans, open Workers’ Compensation files, or auto claims. Confirming the appropriate coordination of benefits prior to claim submission eliminates time wasted on denials and rejections and increases cash flow by preventing denials and rejections before they occur. With SSI Pre-Billing Eligibility, providers can resolve demographic issues before patients are billed.

With SSI Pre-Billing Eligibility, your organization can…

  • Prevent downstream denials due to the specification of incorrect insurance
  • Lower A/R days by minimizing denied or unpaid claims resulting from insurance coverage issues
  • Achieve continuous process improvement between back-office and front-office staff
  • Confirm payer-provided demographic and dependent information, which can be fed back into the information system
  • Secure a final check for substandard patient access processes or apply to service lines or physician groups lacking thorough patient access processes
  • Mitigate potential HIPAA breaches from misrouted EOBs due to erroneous registration information

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