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Payer Solutions
Your Complete Solution to Adjudicating & Paying Provider Claims
- Developed in partnership with DSS, Inc. and Alpha II, Inc
- Centralized claims processing and authorization management
- Effectively and accurately auto-adjudicate claims
- Manage provider payments in accordance with industry standards
Whether you need a total solution or components that will modernize your existing processing capability, CMS and our partners can provide you what you need.
Fee Basis Claims System (FBCS)
Fee Basis Claims System (FBCS) is designed for commercial use in a hospital setting to improve purchased care claims management and adjudication. It brings efficiencies to the processing of claims as well as provides a knowledge base of information needed to strategically guide the decisions made about outsourced care. Through the use of Optical Character Recognition (OCR), data from paper claims (CMS-1500 & UB04) is electronically entered into the appropriate fields in the hospital’s existing data management system.
Features:
- Windows GUI interface and inpatient payment processing
- Integrated GUI Inpatient Authorization management
- Real time match of authorization to claim
- Index and track claims received for processing
- Routine scrubbing of claims against Medicare coding/billing guidelines
- Standardized reporting
- Users can sort their work queues and re-route claims
- Customized letters automatically generated when claim is processed
- Billable Claims Report
- Windows GUI user interface for Inpatient payment processing
Benefits:
- Reduces handling, storage, duplicate entries, and manual data entry of paper claims
- User friendly, clear presentation of payment information allows for process efficiency
- Provides enhanced customer service to Veterans as well as providers
- Streamlines procedures and processes
- Accurately collect and report claim data
v4.0 Update / System Upgrade Now Available
Key elements of the FBCS upgrade:
- Automated processes increase claims intake speed by 2000%
- Fully browser-based system reduces IT cost by 90%
- Single Sign-On (SSO) reduces staff login times by 80%
- Rules-based auto-adjudication of claims reduces processing costs by over 30%
- Centralization of access, storage, and reporting of data provides a single point of entry for all staff
- Dashboard metrics of national data, with drill-down capability, provide instant organization-wide point-in-time and trend visibility to administrators and stakeholders
- Enhanced user-configurable rules, policies and settings foster system-wide standardization of processes
Insurance Capture Buffer
Insurance Capture Buffer (ICB) is designed for commercial use in a hospital setting to reduce data entry errors during the patient registration process. ICB allows users to scan the patient’s insurance card and through the use of optical character recognition technology, the patient’s insurance information is electronically entered into the hospital’s insurance buffer file for final verification.
Benefits:
• Capture and save insurance data electronically
• Conduct query-based searches
• Receive alerts to update patient insurance
information
• Save updated data to VistA’s Insurance Buffer File
• Save scanned images to VistA Imaging
• View work lists of patients with scanned cards
• Compare existing VistA data against scanned
insurance card image
Complete Medical Solutions
14707 Perkins Rd.
Baton Rouge, LA 70810
Phone: 1-800-256-2803
Fax: 225-752-9998
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