Since becoming employed wtihin the Healthcare IT Software Solutions space, I find myself learning so much about healthcare, and the healthcare system – i.e., claims processing, adjudication, EDI (Electronic Data Interchange), and EDE (Electronic Data Exchange). I am continually fascinated with the solutions I am engaged in marketing and selling. For instance, the product I am working with now is a solution for claims processing. The solution is not adjudication software, rather software that works in conjunction with adjudication software.
I overheard one of the technical members of our team call eClaims "the robotic typist” today. A fascinating concept I thought to myself…one I asked him to elaborate more on for me. As he began explaining how the software worked, and the decisions it made, I thought wow! I am a huge proponent of business process automation and love anything that makes life easier; he had my attention.
I was amazed at the decisions eClaims was able to make pre-adjudication. The software almost eliminates the need for human interaction downstream during adjudication. To elaborate on this, interactions and manual entry are necessary during adjudication when errors occur as the result of rejected files during processing. Errors during adjudication processing often occur as the result of human error upstream - i.e. the wrong number on a form, or missing information on a form such as: HCFA, CMS 1500, UB92. eClaims corrects any problems in processing pre-adjudication by scubbing the data.
All adjudication systems accept claims but some do it poorly or have problems with the format the provider is sending the claim in; eClaims eliminates this problem. eClaims also has an entire host of other features which make it a truly amazing product.
I look forward to helping automate and fine-tune a process which costs organizations tens of millions in lost revenue annually.
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