[Back to Overview] Frequently Asked Questions Following are answers to some of the most commonly asked questions about ClaimCorrect . To find the information you want, scan through the list of Q&As below. Q. Why do I need ClaimCorrect? Q. Who benefits from using ClaimCorrect ? A. Any provider who submits claims to any third party payer and has received delays, suspensions, or denials of claims resultant to inaccurate coding or data entry. A. Any third party payor who would like to reduce costs associated with claims auditing and review, and to verify that submitted claims are in accordance to their established rules and guidelines. A. Electronic claims clearinghouses who desire to add value to their services. Q. What is the data source for ClaimCorrect ? A. The data consists of a shadow file of provider's uploaded billing files. This is accomplished through an interface with the provider's billing software, billing service, or claims clearinghouse. A. Peer data is compared to individual providers within the same specialty for like ICD-9 and CPT-4 codes in a geographical area (currently national). Q. What types of claims are monitored? A. Medicare, Medicaid, HMOs, PPOs, Commercial, and other third party payers, etc Q. How often is the claims edit database updated? A. The database may be updated as often as daily, depending upon payer requirements and code updates. When the data has been revised, so has the process been revised - instantaneously and transparently. Q. Why is this process so important? A. When a payer makes a change to a coding rule, they must notify their providers and clearinghouses, who must then update their system/process. And sometimes, this doesn't happen the way it should. The notification gets lost, misplaced, not properly entered, or not entered at all. All of this costs providers and payers time and money. When PRSUroSC is notified, thousands of providers are simultaneously updated. No muss, no fuss. Q. How is patient and physician confidentiality maintained? A. The entire ClaimCorrect system, including the interface, utilizes 128-bit encryption technology, which represents state-of-the art Web security. The provider is able, through use of a login and password, to restrict access even within his/her own organization. Other users are unable to access the providers data. Provider peer data is blended with all other providers and is never individually identified anywhere in the system. The data generated from the physicians claims becomes part of the PRSUroSC database against which other claims are compared. Accordingly, no patient identifiers (name, address, etc.) are exported into this database. We recognize the importance of protecting personal and financial information. As an Internet Application Provider servicing the Healthcare Industry, PRSUroSC must obtain personal information about you and your patients. This information assists us in servicing your account. We know you may be concerned about how we protect this information as well as your account information. How does PRSUroSC protect customer information? The secure server software (SSL) encrypts all information you input before it is sent to us. Furthermore, all of the customer data we collect is protected against unauthorized access through the use of firewall technologies. Since ClaimCorrect is HIPAA compliant, no unauthorized personnel will have access to any information contained in the system or database. What about "cookies"? Q. How does ClaimCorrect receive claim data? A. The data is electronically transmitted from the provider, electronic claims clearinghouse, or payer through a PRSUroSC interface (supplied by PRSUroSC for most major systems). Q. Is special software needed? A. The interface is provided by PRSUroSC as part of the enrollment process. The provider/payer/clearinghouse can utilize a compatible Web browser and an Internet service provider of his/her choice. Q. Do I need to change my internal claims submission routine? A. No. Whether you submit claims directly, or go through a claims clearinghouse, PRSUroSC will develop an interface and audit reporting system for your current routine. If errors are found in the claim files submitted, the provider will be notified of these errors within the ClaimCorrect application. Upon review, the provider can initiate corrections to the claim records and submit "clean" claims to the respective payers or clearinghouse. Q. What is the implementation process? A. No software implementation is required because the entire system is Web-enabled. A web browser and Internet access is required. The user will be instructed as to the uploading procedure. Q. What are the terms of a subscription to ClaimCorrect ? A. The subscription to ClaimCorrect is for three years. Q. How does a user access the ClaimCorrect reports? A. ClaimCorrect is accessible via the web 24-hours-a-day, seven-days-a-week. The user logs onto our website using his unique user name and password. Q. What support is available for additional questions that may arise? A. ClaimCorrect Customer Support is available by telephone toll free 1-800-824-2133 x 340, Q. How does ClaimCorrect measure-up to its competition? A. That's a tough question, since a comparable product does not exist. ClaimCorrect is, literally, "Cutting-Edge" technology. [Back to Overview]
|
|
