Access Management

Address Validation enables health systems to determine address deliverability in real-time, at any point in the revenue cycle. Accessing the USPS Address Matching System and other critical sources, the most accurate information available is returned to the registrar, helping eliminate payment delays and issues with patient communications.

ID Validation reduces input errors by confirming a patient’s / guarantor’s identity, and obtaining updated demographic information, along with current address and phone number. The solution authenticates identity by linking individuals to their name, social security number, date of birth, and any current or former address, without requiring a credit check. This information is used to highlight differences and guide staff’s follow-up action according to your organization’s business rules. With ID Validation, front-line staff are empowered with current information and enabled to ask the right questions, while still engaged with the patient—without requiring patient permission to verify.

In a perfect world, registration staff would obtain accurate information and verify insurance coverage for every patient, every time. But how do you ensure you are achieving this objective? Access Director Eligibility integrates with your EMR to initiate a real-time eligibility inquiry during the registration process, as soon as necessary data elements are entered, and returns an easy-to-understand 271 customized response based on the services the patient is at your facility to receive.

Medical Necessity provides the front-end solution to quickly and easily check diagnoses and procedures against Medicare LCD & NCD rules, along with OCE and CCI edits that can cause claim rejections. The tool helps determine whether a Medicare service is medically necessary to help ensure the provider receives payment. If a service is not reimbursable, it provides registrars with an ABN for the patient including the potential patient financial obligation, which protects against unexpected liability for charges, allegations of Medicare fraud and potential fines for billing of uncovered services.

SSI Prior Authorization powered by Myndshft first determines if PA is required and sources the appropriate submission form utilizing a proprietary Payer Rules Engine and Policy Library that identifies PA requirements based on the payer, plan, and CPT or HCPCS codes provided. It then pre-screens PA submissions for errors and medical necessity, piping in relevant data including clinical encounter details directly from your system of record using industry-standard HL7 FHIR APIs. Next, the solution submits the PA request directly to the payer with any attachments included. Lastly, the PA request statuses are monitored in one convenient location, with PA approvals returned directly to your system.

Admission Notification automates the notification process to ensure timely notice of inpatient hospital admittance to payers, creating a more simple and seamless workflow for your access team. On-screen alerts based on payer business rules empower staff to quickly and easily comply with payer requirements and appropriately follow internal protocol. Users can ensure accuracy by pre-filling data, and strengthen compliance with a system-generated worklist of pending admission notifications. Through use of the solution, health systems eliminate the effects of human error, strengthen compliance, and maximize reimbursement efforts.

SSI Estimation applies intelligent logic by calculating procedural charges, analyzing historical data, evaluating contract pricing between your organization and the payer, and applying patient benefit information to establish the patient’s estimated financial obligation at the earliest point of contact. Automated intelligent guidance directs the complex discussion of the patient’s financial obligation via customized scripting, allowing staff to provide consistent messaging and improve the patient’s experience.

SSI Financial Clearance helps increase collections, both up-front and over time, by providing the guarantor’s propensity to pay while simultaneously notifying registrars of potential financial aid or charity care eligibility. Armed with accurate patient financial information, health systems can then customize individual payment programs to align payment policies and patients’ payment capabilities.

Payment Processing simplifies the billing process, offering the flexibility required by health systems and patients alike. Integrated with a user’s registration and accounting systems, the solution allows payments to be processed over the phone, online, or in person before, at, or after the time of service. The eBill component provides comprehensive and secure online billing and payment management for hospitals, and accelerates payment by enabling patients to access, and act on, account balances from nearly any electronic device. Hospitals can easily collect copays, remaining balances, and outstanding deductibles, with multiple patient payment options available.