ClaimsManagement


 

Claim Edits

HeW's claim management software, eX12 helps clients achieve their Revenue Cycle Management goals. This HIPAA compliant, browser-based application is compatible with Practice Management or Hospital Information Systems. It securely transmits primary, secondary and tertiary claims, allowing HeW clients to manage claims from the point of submission through adjudication.

Clients have the ability to efficiently correct claim errors and edit as needed. Clients may also request custom edits, giving them the flexibility to meet the specialized needs of their organization.

Scrubbers

HeW simplifies claim management processes by offering custom coding, or scrubbers. These scrubbers eliminate repetitive errors or constant conditions, thus reducing the manual effort involved in managing claims. Scrubbers also significantly reduce the number of erred claims, improving first-pass rates and reducing claim denials.

Payer Edits

HeW provides a robust suite of transactional edits to ensure clients achieve high first-pass rates. The HeW editing suite includes validation of transactions against the following policies and standards.

  • HIPAA Levels 1-7
  • CCI
  • NCCI
  • Medicare NCD & LCD
  • Custom payer edits; such as duplicate claims checking
  • Payer Specific Usage Edits (Age & Gender)

HeW also monitors payer rejection reports to identify additional edits to improve future processes.

Clearinghouse

HeW has connectivity to nearly 2,000 health insurance carriers and trading partners. To ensure the most rapid transmission route possible, HeW continually pursues exclusive arrangements and direct connectivity with payers most predominantly used by clients. Transactions are transmitted daily and all transactions are reconciled to ensure they have successfully reached their destination.

Electronic Remittance Advice

HeW clients are able to receive Electronic Remittance Advice (ERA) from a variety of payers. ERA provides payment information more rapidly than traditional paper alternatives. Clients can download, post, view and/or print payment information available within the transaction. These features allow clients to select the most efficient ERA process for their organization.

HeW clients may also use ERA payment information to rapidly bill secondary claims and track denials.

Click here to download a full brochure.

Secondary Claims

HeW provides a secondary billing solution allowing clients to choose the option most efficient for their business. Using eX12, clients may coordinate benefits by entering, uploading, or auto-posting electronic remittance files to create secondary claims.

At the click of a button, these options enable HeW clients to bill secondary insurance carriers electronically and take advantage of the full editing suite. HeW’s secondary billing solution enables increased efficiency and improved revenue cycle performance with accelerated payments, resulting in reduced A/R days.

Click here to download a full brochure.