Claims Editing

One Health System understands the complex issues surrounding payor adjudication. Minimizing wasteful time and money adjudicating claims with errors is critical to the efficiency and bottom line of your organization. OHS Claims is a robust, scalable, high speed yet easy-to-implement rules engine designed to meet the ever changing requirements of your environment and the healthcare industry.

OHS ClaimsFeatures:

• All industry code sets and procedures – CPT/HCPCS/ICD9, diagnoses, CCI, LMRP, revenue codes, DRG, occurrence codes, value codes, treatment codes, etc. – are fully supported and automatically updated as revisions are announced

• Edits can be customized on any field to meet specific needs without software programming or expensive professional services

• Supports 837P (professional), 837I (institutional) and 837D (dental) claims

• Implemented on a local server or via ASP allowing fast integration

• Rules engine runs at blazing speed without sacrificing accuracy

OHS Claims Advantages:

• Rapidly and precisely identify and eliminate incorrect and incomplete claims before they enter adjudication processing

• Significantly increase first-pass adjudication rates and reduce re-submissions

• Decrease suspense processing

• Decrease false accept processing and losses

• Provide immediate and explicit feedback to improve provider behavior and relations

• Focus knowledge workers on critical business activities