The Insurance Discovery software is a blend of knowledge from the medical billing industry veterans and state of art Artificial Intelligence technology. The combination spans about 15 algorithms that help in the search and retrieval of accurate insurance demographic for a particular Date Of Service. The tool has the ability to provide the effective date of the policy if available. The software is built in such a way that based on the payor response trends, the tool will be able to update the algorithms.
The User Interface (UI) is simple and user friendly, the software requires a few key patient demographics such as the following –
- The Billing provider name
- The billing provider NPI
- Patient’s name
- Patient’s full address along with the ZIP code
- The patient’s Date Of Birth (DOB)
- Social Security Number (SSN) which is optional and can be an added advantage
By providing the details the software will be able to retrieve the current responsible insurance data along with the coverage and benefits information. The uniqueness of the tool lets the service provider front office staff who interact with the patients directly and the Backoffice staff who don’t interact with the patients to identify their coverage and confirm the insurance demographics provided by the patient.
The Insurance Discovery tool’s demographic retrieval capabilities are not limited to the commercial/ private payers, the capabilities extend to both the federal insurance Medicare and state funded Medicaid payers. The Insurance Discovery tool can also be used by Charitable organizations to validate the financial status of the patients below poverty line to for any waivers to be considered. The tool has the ability to retrieve the patient’s insurance policy identification number and the group # if applicable.
To utilize the Insurance Discovery for Medicare, we will need the patient’s mandatory demographic details along with the Medicare PTAN and rendering provider NPI.
For Medicaid payer while using the Insurance Discovery tool we will need the patient’s mandatory demographics along with Medicaid PIN and rendering provider NPI to retrieve data.
Especially in Health Maintenance Organizations (HMO) situations wherein the patient may be aware of only the home health plan, the Insurance Discovery tool helps in identifying both the health plan and the Medical Group responsible. Along with the current insurance details the Insurance discovery tool provides the COB (Co-ordination Of Benefits). The HMO’s usually have a shorter filing limit for claims than Preferred Provider Organization (PPO) or Point Of Service (POS) insurance plans, therefore it is very necessary to file the claims to the correct medical group to avoid denials pertaining to untimely filing.
In brief the preciseness and detailed insurance information retrieved by the Insurance Discovery tool, provides insights to the CBO on the current responsible payor including Managed Care organizations, federal payers both Central (Medicare) and state funded (Medi-caid). Identifying the correct responsible party enables the CBO to file the claims reducing the lag days and faster resolution of claims reducing AR days. Reduction of the AR days and self-pay patients portrays a healthy practice.
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