Increase your organization’s clear rate by identifying and correcting Claims errors before they are processed. Adeptia supports human workflow that allows your business users to quickly identify, correct, and resubmit claims in minutes. Together, Adeptia’s Solution allows you to unlock millions of dollars in claims that traditional solutions lose sight of.

Vendors that provide billing clearinghouse solutions to Payers and Healthcare providers often do the client data processing manually or hand it off to IT. The problem is two-fold: 1) they limit the amount of service vendors can offer and; 2) this creates a huge backlog of claims that go untouched for months. Vendors get paid from the client when HIPAA 837 Claims information is successfully sent to the Payer, and processing errors delay revenue. Adeptia’s Claims Onboarding Solution enables Healthcare providers the automation required to receive Claims from the clients, apply business rules, and send valid claims to the Payers. 

Claims Onboarding Solution Overview

Adeptia’s Claims Onboarding Solution automates and accelerates your billing processes which are often obstructed by data integration challenges that requires IT rather than business to fix these claims — such as getting the data from backend systems, understanding the errors, and applying business rules to fix them before sending them to Payers. And all these tasks require weeks of back-and-forth iterations between IT and Business to resolve these issues, which further delays revenue. The key reason for this disconnect is that organizations often choose a technical tool to fix what is essentially a business problem. IT custom codes or uses a very technical “engineering centric” toolset (that only they know how to use) in order to fix the data errors, and the code needs to be constantly updated and retested whenever a new set of data exceptions or a specific Payer related issue are encountered.

Backlogged HIPAA 837 Claim applications that require corrections related to incorrect Social Security Numbers, incorrect Provider IDs require different validation rules that business typically requests IT to perform which takes weeks or months to fix. Validation rules can be per client or type of message. The tasks related to managing Claims processing becomes an IT function rather than a business function. Additionally, the schemas of the HIPAA 837 Claim may need to be tweaked for a particular Payer to handle their custom field or a segment.

A Simple Graphical User Interface For Business, Plus Tools For IT To Govern And Provide Access To Data

As a result of acquiring technical toolsets, business cannot perform these functions on their own. They instead wait for IT to respond to their requests that can take months to resolve. Business cannot bill their clients until they are able to fix and send claims to Payers. The entire revenue model is based on IT’s resource availability and their priorities.

Ask this simple question

Who are the custodians of the Claims onboarding and billing process? Is it business, IT or both? We think it’s both. Adeptia believes that business should be able to perform business functions using a simple, graphical user interface that allows them to access incoming or backlogged Claims, apply validation rules and utilize human workflows to review and correct data or reconciliation errors before sending them to Payers. Additional features such as dashboards to track pending Claims that are flagged as exceptions with detailed error descriptions also play an important role in helping business deliver their services quickly and expedite the billing process. IT plays an important role through data governance by securing and providing access to the data. 

Other integration tools require a high degree of technical competency to support the daily operation of Claims handling. This is one of the biggest reasons why Adeptia enables less technical business users to be able to interact with and monitor the status of Claims.