CareMedic Systems

Consolidated Payment Management

The Challenge

Provider organizations serve a wide constituency of individuals insured by over 3,500 commercial, managed care and government payers. Providers receive notification of payment in a variety of formats, including paper-based Explanation of Benefits (EOBs) and electronic ANSI 835 remittance advice transactions. Each transaction can contain remittance information for hundreds of individual patient claims.

Managing this information presents a number of challenges, including:

• Identifying and capturing payment information from multiple sources
• Manually posting data from paper remittances
• Posting electronic remittance data into systems not designed to receive standard imports
• Indexing, storing and retrieving scanned paper
• Accessing and reporting on payment and denial information
• Reconciling payer remittances to actual payments

The Solution

Consolidated Payment Management (CPM) is an ASP-based, all payer solution for managing remittances. CPM provides tools and resources to help you efficiently manage and automate payment processes—from capturing payment detail regardless of the source, through posting and reporting the data. CPM comprises the following components:

• 835 Gateway
• EOB Conversion
• EOB/835 Viewer
• Remittance Posting
• Remittance Reporting

EOB Acquisition and 835 Gateway
CPM eliminates the challenges associated with managing the numerous connections necessary to capture payment data. CPM automatically retrieves scanned copies of your paper EOBs and associated checks directly from your existing bank lockbox. It also automatically retrieves and validates electronic 835s from your payers, and routes the data to the appropriate CPM components for processing.

EOB Conversion
Once batches of scanned EOBs and associated checks are retrieved from your existing lockbox, CPM automatically converts the payment data to a standardized ANSI 835 electronic format. CareMedic delivers the 835 file to you, and you can either post the data into your patient accounting system, or use CareMedic’s Remittance Posting solution to automate posting, which eliminates labor-intensive, error-prone manual processes.
 
EOB/835 Viewer
The EOB and 835 Viewer streamlines and simplifies filing, storage, retrieval and distribution of scanned paper documents and electronic data in one easy-to-use solution, putting information in the hands of the people who need it. The viewer gives your staff vital information from the scanned EOBs and single-patient 835 remittance views so they can answer questions from patients and insurance companies, immediately edit and resubmit bills online, and reconcile remittances.

Remittance Posting
The CPM Remittance Posting module eliminates the time and errors associated with manually keying remittance data. A client server-based application, Remittance Posting automatically receives all of the 835s from the 835 Gateway and EOB Conversion process and posts the associated payments electronically to your patient accounting system. The remittance process emulates an expert payment poster’s knowledge, using decision rules defined by your organization that allow the system to process payments using a virtually unlimited number of scenarios.

Remittance Reporting
CareMedic’s OptimizeAR Remittance Reporting is a data mining solution that harnesses the information contained in your ANSI Standard 835s and the information contained in 835s created during the EOB conversion process. It allows you to easily analyze the root causes of denials, spot trends, and focus on payer issues to help reduce future denials.

Benefits

For more information, contact us via the Web or call us at 1-800-508-8494.