Streamlined Workflow for Claims & Appeals

Submit Clean, Compliant Claims the First Time

Submitting claims created with the proper specifications for each payer greatly reduces denials. With more than 60 validations and rules performed, our rules engine provides simplified workflow and reduced denials by doing everything from:

• medical necessity checking,
• to proper grouping and pricing for bundled CPT codes,
• to the application of MUE rules, and
• split billing for your professional and technical components.

To reduce your DSO, TELCOR RCM processes initial claim status response information allowing you to proactively correct and resubmit problem claims without waiting for the remittance. 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 for easy corrections when information can be updated and the claim resubmitted with tools for assignment, error categorization, and easy update and batch resubmission.

Claim Appeals

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 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 improve visibility into the process by showing denials and appeals in process with associated dollars and expected response dates, the success of denials and appeals to evaluate the adequacy of processes, and productivity of employees working denials and appeals.