Claim Submission & Remittance

Electronic Claims Processing

Completed claims are automatically queued for electronic or paper processing once final scrubbing is performed. The application supports multiple pages for paper claims, and claim splitting and tracking logic for electronic claims with high numbers of diagnoses codes or service codes. The MedcomSoft Record advanced communication and interface engine is capable of communicating directly with a variety of health plans, clearinghouses, outside organizations or other practice management systems. A complete history of filing is maintained for every batch and every claim for better tracking of aged receivables.

Using the MedcomSoft integrated billing system, providers can generate HIPAA compliant 837 transactions (electronic claims). In order to ensure the maintenance of high-level quality assurance MedcomSoft has been certified as HIPAA compliant for sending ANSI 4010A1 837 Professional transactions by EDIFECS, a leading third-party organization specializing in HIPAA EDI compliance certification.

Payment & Adjustment Posting

MedcomSoft Record has advanced tools for inputting, reviewing, posting and locking individual and batch payments, adjustments, write-offs, refunds and reversals. Auto-calculations of contractual adjustments in contracted scenarios are done as the system retrieves fee and allowed amounts from fee schedules and performs the calculations, saving back-office resource time.

Batch payments and distributions are easily managed as payments across multiple claims can be quickly posted due to the streamlined batch payment entry system.  Co-payments can be entered upon payment entry and later 'applied' to the patient visit as necessary.

Electronic Remittance Advice Management

MedcomSoft Record allows all of these functions to be done and managed through the electronic remittance advice capability, and includes comprehensive and powerful functionality to allow the full review, editing and control of all incoming ERA data to ensure that all accounts are properly reconciled and balanced at all times.

The innovative ERA management system accepts industry standard X12 835 files to allow users to electronically receive post and distribute payments and adjustments to the system from payers. Electronic insurance payments are matched by procedure and line-item thereby enabling a real electronic Explanation of Benefits (EOB) system.

It has powerful functionality to ensure correct matching and reconciling of transactions, as well as extensive support for bundling and unbundling of services, provider-level adjustments, MOA codes, interest, tax and more.  Adjustment codes and payment levels are tracked to provide a detailed analysis of payor reimbursements and necessary fee schedule adjustments.

Features & Functionalities