With more than 60 validations and rules performed, our rules engine provides simplified workflow by doing everything from medical necessity checking, to proper grouping and pricing for bundled CPT codes, to application of MUE rules, and split billing for your professional and technical components. This rules engine, combined with automated eligibility checking, allows you to submit clean compliant claims the first time which greatly reduces claim denials.
TELCOR RCM processes initial claim status response information allowing you to proactively correct and resubmit problem claims without waiting for the remittance, reducing your DSO. When legitimate denials are received and you perform claim appeals, TELCOR RCM has dedicated workqueues to efficiently turn around the claims for resubmission. Workqueues for claim denials allow easy corrections when information can be updated and the claim resubmitted with tools for assignment, error categorization and easy update and batch resubmission.
Workqueues for claim appeals allow multiple levels of appeals to be managed. Appeal letters and forms can be pre-configured and automatically generated along with accompanying claims based upon user-defined schedules. Appeal levels and turnaround requirements can all be defined per payer to allow management to ensure appeals are sent and received according to the payer requirements.
Simplified workflows for claim management reporting improves visibility into the process by showing denials and appeals in process with associated dollars and expected response dates, success of denials and appeals to evaluate adequacy of processes, and productivity of employees working denials and appeals.