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medical claims management

Medical Claims Management Software Solutions

Medical Claims Management

Claims management software help organizations to create and deploy automated and agile claims management processes for full-proof claims processing. Healthcare claims management software solutions play a vital role in solving the challenge of increasing claims denial rate and stringent federal regulations. OSP offers customized claims management solution that seamlessly integrates multiple complex systems, platforms, as well as manual processes to automate medical claim processing workflow throughout the claims life cycle. Our medical claims processing software solutions are equipped with intelligent integration abilities that work in complete synergy with existing administration systems and future cloud-based innovations. Our tailored medical claims management solutions help in checking for coding and billing errors, sending an EOB, pre-adjudicating the claim for accuracy and more.

THE GROWING CHALLENGES

The common bottlenecks which might slow down your business growth

Complex medical billing Procedure

Manual Workflow

Slow and outdated claims processing with major disparities in process workflow management.

Outdated Analytics

High Denial Rate

Manual billing resulting in claims errors, eventually increasing the claims denial rate.

Workflow Efficiencies

Slow Process

Time-consuming claims management affecting revenue management cycle and earnings.

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Regulatory Compliance

Inability to maintain necessary regulatory compliance like HIPAA leading to heavy fines.

Edit Errors

Inability to edit errors before sending the claims to the clearinghouse for scrubbing.

Manual Claims Adjudication

Slow and traditional claims adjudication systems affecting the speed and efficiency of RCM.

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HOW OSP WORKS

Medical Claims Management Solutions Process

Optimize your claims management strategy to reduce denial rates and administrative costs.

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Solutions

Claims Integration

Claims integration is the best way to provide automated and easy access to their health records and medical claims in one place. Healthcare claims management is a highly complex process. It can be made simple by customized medical claims processing software with the claim integration system. Tailored billing claim medical software with claims integration allows easy access a digital archive of all the records, including medical, dental, prescription, and vision services.

OSP’ solution to claim processing system in healthcare can help you to track bills, payments, and annual deductibles automatically. We customize billing claim medical software to simplify quality control maintenance, to maximize productivity & compliance. Multiple models of claims integration with patient accounting make our tailored claims software solutions comprehensive and flexible. OSP’ engineers claim management solutions with claims integrations for claim submission to payor notification dates, payor acceptance, and rejection data, claims status, eligibility, ERA and denial information.

Claims Review Management

A medical claim billing software needs a proficient claims review management to support the accurate coding of claims that result in fair, and transparent payment policies. An ICD-10-compliant medical claims management software that evaluates claims information helps providers to decrease the rate of denials. Top-notch claim administration software solutions have claim review management systems that include CPT/HCPCS procedure codes to identify coding errors and conflicts to make recommendations for correction for both professional as well as facility claims.

OSP can program health claims processing software with preconfigured coding rules. We create next-gen claim software solutions that provide the clinical foundation of rules and logic essential for intelligent claim edit results. Through claims management solutions, we strive to improve provider payment transparency by sharing claim edit rules, source data, and complete clinical rationale for potential claim edits with providers through your payer’s website.

Claims Management Reporting

Reporting is one of the most underrated yet essential modules in a working revenue cycle management system. To better your claims management healthcare solutions finding the common errors and mistakes is important. OSP can help providers with easy-to-use and intuitive reporting dashboards that help to visualize the most common reasons for claim denials and rejections. We customize the healthcare claim administration software to enhance your reporting capabilities and help you plug the revenue leakage across your revenue cycle.

We program health claims software with a customizable reporting system to analyze the claims data in your preferred format with a modern, wizard-like setup experience. Our tailored medical claims management system ensures robust data feeds to enable holistic claims understanding through a big-picture view of your data.  OSP can engineer healthcare claims management software with smart reporting to achieve real-time performance management and learn new ways to boost revenue. Through our made-to-order medical claim software, you can easily build your reports to make cash forecasting and productivity management.

Electronic Data Interchange (EDI)

Electronic Data Interchange (EDI) is the sending and obtaining electronic data using technology. For claims submission, a standalone EDI system is required. Especially for an 837 file that contains patient claim information. For billing and claims management, good quality EDI system allows you to quickly and easily automate the claims processing. It helps in minimizing revenue leakage, boosting clean claim rates, and drive down unproductive manual systems.

We customize medical insurance claims processing software with next-gen EDI systems the can process millions of enrolments, medical claims, and other EDI transactions quicker than any manual system or clearinghouse. Health claims management process is made compliant by implementing the SNIP levels 1 – 7 and getting CORE CAQH compliance. The flow of your EDI can be easily monitored, controlled, and maintained with executive dashboards, smart analytics, and databases, making your healthcare claims management system full proof.

Claims Status Management

Claim software solutions require claims status management to automate the follow-up process for commercial payers by accelerating the provider’s timeline for receiving payment while reducing the cost-to-collect. It is a highly time-consuming and complicated process, made further difficult with limited access to claims adjudication status. By automating the claims status management, the manual claims status checks can be eliminated in medical claims management.

OSP can engineer healthcare claims software that automates the claims status management by retrieving the claims status data from the payers and generate a list of approved, rejected, and denied claims.  OSP’ made-to-order medical claim processing software helps to eliminate the efficiencies of manual status searches to gather more actionable details. Our custom claims management healthcare solutions help to lower A/R days resulting from denied or unpaid claims not being worked in time. By streamlining the claims status management, OSP’ custom-made claim administration software solutions prove highly beneficial for providers.

Remittance Management Solutions

Traditional medical insurance claims processing software requires manual payment postings wasting time and resources that can be utilized on primary processes. An automated remittance management module in claims management software help to manage the entire remittance process and streamline downstream processes to save time and money. Our medical claim management with top-notch remittance management helps you retrieve and capture every ERA transaction from the payors, eliminating the time-consuming follow up when files are not available.

OSP’ claim management solutions stand to resolve issues created by inconsistencies across payor ERA files. It eliminates the need for manual correction often necessary after automated posting processes are complete. Remittance data is posted through batch or key emulation capabilities, including final payments and contractual adjustments, as well as patient liability information and reason codes. Following up on outstanding payments and remittance advice is made easy with our tailored medical insurance claims software.

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Use Cases

What We Offer?

Sentiment Analysis

Denial Management

OSP' custom medical claims software is integrated with denial management analytics that helps to analyze the electronic remittances and segments denial charges in relevant groups. Combined with expert analytics system, it helps you identify the root cause of common denials and set up a process improvement to prevent future, and track results. We engineer claim management software that analyzes remittances to help providers alert the potential denials, uncover hidden issues, highlight error trends, and realize cash opportunities. Full 837 & 835 parsing and unified view of denials across all systems and locations make our denial management comprehensive.

Text Detection

Claims Processing Automation

Claims Processing automation offers end-to-end capabilities for full claims control. OSP' custom medical software is based on advanced claims processing automation solution delivers measurable advantages by flexibly integrating with the Policy Administration and Reinsurance modules to offer the user with exact time coverage verification based on the reported date. It also combines Client and Policy data directly into the Claim. Claims processing automation offered by out custom claims processing software helps in reducing claims management costs with better processing time.

Facial Detection

Coding Edits

We program medical claims auditing software with advanced coding edits helps to edit the claim files prior to their submission. Detailed claim scrubbing can enhance claim validity, increase cash flow, and demonstrate clinical defensibility. Procedure code edits, medical necessity edits, procedure code edits, claim-level technical edits, outpatient prospective payment system (OPPS) edits, and file format edits are handled by our claims administration software solutions for better accuracy, lower claims denial ratio, and enhanced revenue.

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