Each day, the Epic system generates a claim file which is then translated into SSI billing. These claims are compiled into the SSI Billing Package. Valid claims are subsequently merged and transmitted to the payer. A Daily CRD file is returned to Epic regarding claims with edits, and including details such as the patient account number, claim status, edits that are on the claim, edit descriptions, and edit category. This allows clients to route claims that need attention to work queues within Epic, using the category codes within the Epic system. The process of translating, reviewing edits in Epic, modifying the claim in Epic, and then retranslating an updated claim can take many days to lead to a claim being clean, which is where Rapid Retest comes into play.

To enhance this process, SSI utilizes real-time validation – this removes the need to wait for a nightly claim run to identify whether or not the changes they are making on claims will lead to the claim being in a valid status.

Once the errored claims go into an Epic work queue for a biller to work, they can make modifications and change what they need to and click “Refresh Claim.” After this happens, Epic creates a single 837 claim, which is routed to SSI via secure SFTP. That single 837 claim is going to be evaluated by an SSI validation service instead of going into the SSI billing package. SSI then provides feedback on the status of that claim, whether valid, still in error, category codes, etc. This information is provided via 277ca code transaction that is returned to Epic via the VPN immediately. The biller doesn’t have to wait for the nightly claim run or the next day.

Within seconds, the biller knows if the changes they made to the claim are valid. If the changes corrected the claim, they are in good shape. The claim will still need to be made available for the next claim run, however. So the next day, the claim that you already worked that you know is going to be valid, can be picked up on the next day’s claim run. If a claim still needs to be corrected, the client can evaluate as many times as need be by hitting refresh – instead of waiting an entire day for the subsequent claim runs. This real time validation is the value behind the Rapid Retest Functionality. Rapid Retest provides real time feedback in order to shorten the accounts receivable days.

SSI Focuses on Denial Prevention

Ninety percent of denials are preventable and are a failure of the billing process. There are a variety of root causes for the denials including eligibility, missing or invalid data, authorization, non-covered service, and missing documentation. SSI’s tight integrations with Epic help prevent denials throughout the cycle.

Here’s how we focus on denial prevention:

• SSI Solutions focus on editing and billing correctly on the first pass, which results in one of the highest clean claim rates in the industry.
• Our vast number of direct connections to your payers helps expedite the time to payment.
• SSI Rapid Retest functionality allows claims to be pushed back to Epic to be reworked, which also results in a more efficient claim reconciliation with Epic as your source of truth.

The SSI Edit Advantage

SSI’s comprehensive edits for both hospital and physician billing claims allow users to create custom edits and rules within the claim scrubber and within Epic. Our robust edits suite includes all significant types and classification of edits – for all payers, multiple payers, and Medicare-specific.

SSI’s edit suite includes local and national coverage determinations, correct coding initiative edits, medically unlikely edits, Medicare code editor, add-on code, and outpatient code editor.

Experience Matters

The experience of the SSI Edit Team is second to none. The average tenure of the team is 18 years, which is time that has been spent cultivating a deep knowledge in the area of edit development.

In addition to the edit knowledge our staff has, SSI also allows the client to control the edits specific to their package. This includes Claims edit bypass—which allows users to override SSI edits from within Epic when a bypass is required.

SSI allows for provider-level edits including provider customization in leveraging its edit rules engine, plus we allow the client to control enabling and or disabling any of the edit types and suites mentioned above. This includes allowing client control to modify active dates and active payers at an individual level for HCPCS, CPT4 and the ICD10 tables.

Additional SSI Functionality

Rapid Retest

SSI’s integration to offer Rapid Retest (ACRD) builds on Standard Claim Reconciliation Data (CRD). Rapid Retest is a collaboration between SSI and Epic that builds on CRD functionality, reducing the accounts receivable days associated with our clients’ erred claims. To put it simply, Rapid Retest is Accelerated Claim Reconciliation. This functionality helps our clients work in our comprehensive edit suite to check edits in real-time by refreshing their Epic claim screen instead of waiting for claim upload times.

Payer Status Query

Payer Status Query is an EDI X12 276 transaction that is an additional Epic integration. Epic uses web services to send and receive the X12 messages. This X12 276/277 transaction utilizes real-time payer response and allows transactions to be sent within Epic to prioritize the work and eliminate follow up for claims that have been paid or scheduled to be paid.

External Edit Return

SSI’s ability to provide external edit return with categorization allows Epic to route claims to appropriate work queues within Epic based on information in the file using Edit Category Codes. The Epic Category Codes automate the distribution of claims to the appropriate work queues and allows for edit mapping.

Attachment Solutions

Attachments refers to the exchange of patient-specific medical information or supplemental documentation to support a claim (837) transaction. More than 30 percent of all claims will require some type of supporting documentation from a provider or hospital system. This equates to more than 102 million attachments processed annually. According to CAQH CORE, each claim could cost $6 – $45 or more to receive, review, prepare, and send (using traditional methods like mail and fax). SSI has a solution to these challenges.

SSI’s Epic Attachments allows our partners who leverage Epic to route claims and their associated attachments /documentation to payers electronically without leaving Epic. This allows providers to utilize Epic for both claims & attachment processing and they can work solely inside Epic for all their activity.

Other advantages to SSI’s Attachments include the training taking place inside Epic. The process is also tested in both Epic and SSI prior to going live, resulting in more efficient and timely claim transactions.

In conclusion, SSI’s seamless workflow integrations with Epic provide hospitals and healthcare organizations with a comprehensive and efficient revenue cycle management solution that allows you work claims within your Epic environment. SSI ensures a smooth end-to-end workflow that optimizes processes and delivers excellent results by leveraging deep Epic integration.

To request a demo, click HERE.

Or, watch our latest on-demand webinar to see why SSI is the claims and clearinghouse solution of choice for hospitals and health systems.

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