Claims & Benefits Management
Improve Your Practice’s Collections
Integration with Clearing Houses and Insurance Providers
There are over 2,000 insurance providers in the U.S. today, some of which operate nationally while others are limited to a single state. Not all insurance providers allow access to their client base, and those who do have various interfaces that can make it difficult to quickly check the validity of a patient’s insurance plan. It is not surprising that between thirty and forty percent of all claims are returned to hospitals unpaid. Clearing houses help reduce these risks, as they offer a uniform interface and regularly updated information that makes it easier to determine whether the patient has an insurance plan, the level of benefits and the responsible payee.
DataArt has solid experience in building software solutions that are tightly integrated with a variety of clearinghouses and thousands of insurance providers, including Aetna, Blue Cross, Blue Shield, Medicare, Medicaid, etc. Our expertise covers all EDI transactions for implementing:
- Eligibility and benefits verification, in real-time or by batch
- Claims submission and status inquiry
- Paper claims
- Payments and transactions management
- Patients statements generation and management
- Bi-directional interchange
Eligibility & Benefits Software Development
DataArt strongly believes that electronic eligibility and benefits verification, also known as a 270/271 transaction, is a key feature that makes it possible for a medical practice to reduce the number of rejected claims, save staff time and generally increase practice collections. DataArt is skilled in developing software solutions that support eligibility and benefits verification and seamlessly integrate with billing systems. This type of software makes it possible to access information on a patient’s copayments, coinsurance, deductibles, out-of-pocket expenses, stop-loss, etc. The healthcare provider, equipped with accurate information, will know the exact amount to charge the patient, and rest assured that the insurance claim will not be rejected.
To help our clients make the billing process more efficient, we simplify use of the Superbill form, which assigns a unique CPT code to each service, procedure or a lab test. With the Superbill, all services administered to a patient during a visit can be represented by a set of CPT codes, which are sent to a billing system that decodes them and creates a bill for the patient or his insurance provider. DataArt has broad experience in creating Superbill databases.