Claims Submission Automation

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Seamless claims management is crucial to the operational and financial well-being of any post- acute care organization. Operational bottlenecks such as resource allocation, data entry errors, etc. in managing claims submissions can result in delayed submissions and lost revenue, negatively affecting the revenue cycle of the organization.

Claims submission automation helps organizations ensure that claims get submitted in a timely and error-free manner to help accelerate cash flow and drastically shorten the revenue cycle. Increased revenue recognition in shorter timelines can go a long way in boosting operational efficiency and help the organization focus on delivering excellent care at lower costs.

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Workflow description

Claims submission automation integrates with various modules within your system of record to validate and process claims to ensure they reach the clearinghouse quickly. Trained software robots apply business rules to validate the claims before submission to ensure zero errors, increasing the likelihood of success before submission.

Access EHR modules to scan for claims

Validate claims utilizing business process rules

Download processed claims from EHR

Upload to clearinghouse for reimbursement

The claims process is heavily reliant on the speed and accuracy of the claim submissions to ensure a healthy, timely revenue cycle. With claims submission automation, organizations and staff no longer need to focus on the information-intensive manual tasks that contribute to operational bottlenecks. They can instead focus on other business-critical tasks to improve the care delivery mechanism. The automation solution accesses various modules in the EHR, namely insurance/self-pay, PDGM, per diem, to process claims in each of them and uploads them to the clearinghouse in a timely fashion.

Access Ins./Self Pay, PDGM, and Per Diem modules in EHR; Process all claims in each module that are identified as “Green” by downloading from EHR and upload to Clearinghouse

Benefits and ROI

  • Reduce the burden of data entry tasks with the help of automation, ensuring validation of submitted claims for the accuracy of details provided
  • Reduce errors, improve error detection & rectification rates before claim submission to reduce denial rates
  • Access simplified dashboards with a quick overview of filed claims, monitor Accounts Receivables (A/R) at a glance
  • Simplify the tedious, repetitive nature of the claims process for clinical, administrative staff allowing them to save time on manual tasks and focus on core job responsibilities
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Claims Submission Automation

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