Claim Review helps you manage the complex rules and terminology of coding. This feature analyzes the claim(s) before submission to the clearinghouse and identifies any issues with your claim(s), maximizing the potential for you to be paid correctly on the first submission. Claim review is made up of 3 parts.
Real Time Claim Submission (RTCS): Real-Time Claim Submission (RTCS) gives you on-demand visibility into your claim. Within seconds, claims are scrubbed for tens of thousands of clearinghouse edits.
The charge must be in the status of “send to insurance via clearinghouse” to use RTCS.
Claim Analysis: Claim Analysis is a built-in clearinghouse edit engine that validates professional and institutional claims for Generic or Payer-Specific Edits. This feature allows you to correct claims before it’s rejected by the Clearinghouse. Analyzing your claim prior to it being sent to the Clearinghouse will save you a significant amount of time on rework.
Code Scrubbing (If the service is enabled): Code Scrubbing is a solution that validates your procedure codes, diagnosis codes, CCI, NCD, LCD, HCPCS, Modifiers, and LMRPs to catch any common errors before the claim is sent to a payer.
Follow the steps below to review a claim.
Select Claim > Claim.
Use the Search field to search for your claim.
Place a check in the “Show exact matches only” box to search for exact matches or “Show unpaid claims only” to show claims that may need follow-up.
Open the claim.
Click the Review button and select one of the following options:
If the claim hasn't been reviewed yet the following message will appear in the drop-down “This claim has not yet been reviewed.”
If the claim has been reviewed, you will see the date and time it was last reviewed and allow you to click “view results”.
A Claim Review Result window will open with a summary of the review.