We use both claim and proration checks extensively, but we also "scrub" our claims prior to submission. We use Emdeon's (well I guess I should say HLTH Corporation since Emdeon has changed their name again) Claim Master product to check our claims for any CCI or LMRP edits. I would be happy to discuss further if you have specific questions.
Thanks, Kim Kim Tilley Citizens Memorial Healthcare Phone: 417.328.6718 Fax: 417.777.7157 [EMAIL PROTECTED] -----Original Message----- From: meditech-l@MTUsers.com [mailto:[EMAIL PROTECTED] On Behalf Of Scaccia, Kimberly Sent: Thursday, June 07, 2007 8:25 AM To: Wiltshire, Sandi; meditech-l@MTUsers.com Cc: [EMAIL PROTECTED] Subject: RE: [MEDITECH-L] B/AR question I think what you are asking for is proration (reimbursement management) and claim holds. These holds stop accounts before they drop a claim for various reasons. In order to set them up, you have to know what you are currently receiving denials for. For example, Payers in contract with a facility may require authorization - and possibly you are getting high volumes of denials for authorizations for a particular payer. Authorizations required by payer can be set up (1) to reject at the registration point, (2) at the point where the account hits BAR (UR Claim Check), (3) at the point where the BAR attempts to post / cut the account (proration or reimbursement management) and at the Claim level. (1) MIS Insurance Dictionary - Required Fields Dictionary - Questionnaires (2) UR Claim Check - BAR, Claim Check Dictionary, Prescreen UR Accounts = "Y" (3) Bar, Claim Check and Reimbursement Management Dictionaries (4) Bar, Claim Check and Claim Dictionaries This is a simple example, but I think you get the point. Not all proration holds can be used as UR Claim Checks and not all Claim Checks can be used as proration holds. We have numerous claim and proration holds as well as admission requirements. These holds stop the account before getting out the door and can be tracked on your DNFB (discharge not final billed) UR Claim Rejections and/or Master Claim Rejection Lists. In C/S (not sure about Magic), the holds can be assigned to 'groups' which allow the reports to pull by the responsible area. For us, the areas are to run them daily to make corrections and the numbers are reported to higher management (dollars and number of accounts). Kim Scaccia, System Admin Recovery Reimbursement Patient Business & Financial Services Halifax Medical Center 386-226-4590 opt 1 ext 2018 -----Original Message----- From: meditech-l@MTUsers.com [mailto:[EMAIL PROTECTED] On Behalf Of Wiltshire, Sandi Sent: Tuesday, June 05, 2007 2:39 PM To: meditech-l@MTUsers.com Subject: [MEDITECH-L] B/AR question Hi, I am posting this for our Director of Pt Financial Services....Thanks for your help, Sandi To B/AR module users: What if any program is being utilized to identify claims that will deny processing either thru MT or the payer systems due to missing information, wrong information etc. I currently have a process when the claim denies for payment once it has made it thru the payer claim edits. What I am looking for is pre submission to the payer. I am interested in collection of the data so that the information can be fed back to the department managers responsible for patient registration. Thanks Terry Hibbert Director, Patient Financial Services Heywood Hospital 978-630-6209 978-630-6153 Fax [EMAIL PROTECTED] Sandi Wiltshire, MT(ASCP),MBA IS Applications Manager Heywood Hospital 242 Green Street Gardner,Ma. 01440 978-630-6112 [EMAIL PROTECTED] =*=*=*=*=*=*=*=*=*=*=*=*=*=*=*=*=*=*=*= To subscribe or unsubscribe to the meditech-l, visit MTUsers.NET. To check the status of the meditech-l, visit MTUsers.NET. For help, email [EMAIL PROTECTED] Visit the MTUsers WikiPedia at MTUsers.NET/mwiki ______________________________________ meditech-l mailing list meditech-l@MTUsers.com http://mtusers.com/mailman/listinfo/meditech-l =*=*=*=*=*=*=*=*=*=*=*=*=*=*=*=*=*=*=*= To subscribe or unsubscribe to the meditech-l, visit MTUsers.NET. To check the status of the meditech-l, visit MTUsers.NET. For help, email [EMAIL PROTECTED] Visit the MTUsers WikiPedia at MTUsers.NET/mwiki ______________________________________ meditech-l mailing list meditech-l@MTUsers.com http://mtusers.com/mailman/listinfo/meditech-l The information contained in this e-mail, including any attachments,is legally privileged and confidential. If you are not the intended recipient, you are hereby notified that any use or dissemination of this message is strictly prohibited. If you have received this message in error, please immediately notify us by telephone 417-328-6526 and delete this message from your system. 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