XClaim:

Claims Management

Our claims management editing capabilities are powered by a proprietary validation engine that can process more than a million edits in milliseconds. The validation engine is constructed from provider- and payer-specific edits, APC, MCE and OCE edits as well as CCI rules and LMRP rules to assure compliance with billing guidelines for facility and professional claims. Because the information is comprehensive and continuously updated, you can count on the consistent production of clean claims that yield quicker and more accurate payments with lower administrative costs.  The result is a significant reduction in AR days, an increase in first submission percentage rates, a reduction in payer rejects and an improvement in overall cash collections.

Real-time Control
A helpful feature of XClaim is a dashboard view of the claims assigned to each biller and the status of each claim. Billers can instantly prioritize the sequence in which claims are worked through multiple criteria such as service date or billed charges. Supervisors have even more comprehensive control, including every claim across the hospital system. They can assign claims to billers with a click, monitor biller productivity and review claim status systemwide to ensure maximum efficiency.

Standardized Payer Reports
XactiMed's proprietary technology automatically converts all payer reports into one standardized format, regardless of the format in which they were received, eliminating the confusion of multiple payer reports. Likewise, all payer reports are presented back to providers in one standard format to increase productivity and reduce the possibility of human error. Throughout the life of the claim, XactiMed records an audit trail of all payer activity.

Automatic Work Queue Rerouting of Rejected Claims
Thanks to payer-report standardization, XClaim can instantly identify rejected claims and electronically reroute them back to the original biller, accelerating resolution and resubmission. The biller also receives the original payer-provided rejection reason in a summary format, further facilitating timely resolution and accelerated cash flow.

Electronic Upstream Resolution
XClaim includes a work scheduling function that permits billers to electronically send pending claims to the necessary departments, such as medical records or registration, for resolution. The claim can be corrected and returned to the biller electronically as well, eliminating time-consuming paper-driven information requests. Online work queues help supervisors manage outstanding claims inventory pending in upstream departments to ensure timely response for high-dollar or aged claims.

Online Claims Clearinghouse
XactiMed manages the submission and reconciliation of all claims through our secure clearinghouse. With hundreds of direct payer connections, automated import and export of claims takes place seamlessly without disruption to users. We reconcile every claim within every batch. If we don't receive a confirmation, we track it down for you and resubmit if necessary.