An efficient billing process starts with an efficient patient appointments module.  ProClaim counts on an extremely flexible appointment module which essentially adapts to any health facility.  The system allows for the creation of multiple appointment books for providers, departments or services that require control of an electronic appointment system.  Users can adjust patient limits, services per day, office hours, holidays, and more.  One of the most versatile features of ProClaim’s appointment module is its capability to verify patient eligibility with a simple click of a button.  This is incredibly helpful in identifying those contracts that are not active even before patients arrive at the office.

• Free texts messages
• Creation of New Appointments
• Reminder and Confirmation of Appointments

Thanks to the integration between ProClaim and the ASSERTUS clearinghouse patient eligibility can be completed in a couple seconds using the information already registered in the billing system.  This makes the process quicker and much more efficient for two main reasons.  First, because users don’t have to input information in another system or web page in order to determine eligibility.  Secondly, by verifying eligibility directly from the billing system, we make sure the registered information is correct.  Besides knowing patient eligibility, depending on the medical insurance, users can find additional patient information such as, to what Advantage health plan they belong, annual deductibles, coverage, demographic information to complete record, among others.  The eligibility does not have to be printed because ProClaim keeps a complete record of patient eligibility, attached with corresponding claims, in case it needs to be printed in the future.

The demographic record is the patient control center, where users gather and validate basic information.  Additionally users have access to a complete record of claims, services rendered to the patient, eligibilities, digitalized documents and others.  At the moment a patient is being registered, the system provides certain controls to avoid commonplace errors that take place when inputting data.  These controls help avoid data duplicity and possible claim rejections.

ProClaim integrates with the vast majority of Electronic Health Records(EHR/EMR) through the communication protocol Health Level Seven (HL7) and others.  This prevents double entry of data, which in turn results in greater integration and consistency for the information stored in both systems.  Typically the system integrates the patient’s demographic data, the appointment and its pertaining information in order to generate the claim for services provided.

*VERIFY WITH ASSERTUS IF YOUR EHR/EMR SYSTEM INTEGRATES WITH PROCLAIM

The key to efficient billing is making sure it’s produced correctly from the beginning.  With that in mind ProClaim provides a series of validating checkpoints throughout the billing process, geared towards preventing common errors during data entry and coding.  Additionally it provides “quick fix” option in case of rejection.  ProClaim also provides efficient managing of complementary, supplementary and secondary health plans.  The delivery and reception of all electronic transactions are done through ProClaim thanks to its integration with the ASSERTUS clearinghouse.  This includes eligibility request and response (270/271), claim delivery, reception of acknowledgment of receipt, claim application status(276/277) and the reception of explanation of payments.  Transmissions can be carried out from any work station within the medical facility for users with the appropriate access.

ProClaim and Claim Controltechnology automatically standardize and analyze each Acknowledgment of Receipt in order to identify rejections in the early steps of the billing process.  The system automatically follows up on every claim until receiving acknowledgment of acceptance from the medical insurer.  All of this occurs without having to exit your billing system.  ProClaim conducts an automatic audit of the acknowledgments of receipt, and as a result the system clearly identifies returned claims due to errors and claims without an acknowledgment of receipt.  This way we avoid “missing in action” claims.  With CClaimControl technology there is no need to print Acknowledgments of Receipt to process them manually, ClaimControldoes it for you. 

ProClaimoffers a true automatic reconciliation for explanations of payment, received electronically from the health insurers. The system allocates the payment received from every claim and automatically detects any discrepancy between what was billed and the payment itself. If any difference is detected, the system automatically generates the original adjustment form of each health insurer.  In case of complementary Medicare health plans, the system automatically generates the CMS-1500 form attached with the payment explanation regarding that specific claim.

• Increase debt collection percentage (%) /  Reduce accounts receivable
• Diminish processing time when generating and following up on claims
• Diminish rejections and adjustments
• Achieve payment promptness for services provided
• Increase personnel efficiency
• Achieve greater user and client satisfaction
• Diminish / Eliminate losses
• Reduce paper usage and inventory

EXCLUSIVELY WITH ProClaim, VERIFYING YOUR CLAIM’S STATUS IS NOW EASIER THAN EVER.  Our constant pursuit of innovation has led us to integrate ProClaim with the capacity of requesting the status of any claim in real time, with NO need to call the health insurance company.

With just a click the user obtain the status of a claim in less than 2 seconds.*

Some Advantages

• Real time status
• Receive status in less than 2 seconds
• Status automatically registers in claim history

Find out if your claim

• Is in the process of allocation
• Was allocated and is in the process of payment
• Was paid, and also see date and CHK/EFT number
• Was denied
• Hasn’t been received

*Claim Status feature is available for participating health insurance companies.

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One of ProClaim’s great advantages is precisely its versatility when generating detailed analysis and interactive reports.  We designed a matrix of all data processed in the system, which helps the user generate reports according to his/her needs.  To avoid printing, these reports can be exported to Excel and PDF.  The most utilized reports in ProClaim include accounts receivable, collection effectiveness, production analysis, health plans, providers, locations, services, and diagnostics.

Main Features

• Patient Appointments – with group eligibility verification
• Appointment confirmation through text message (SMS)
• Automatic eligibility verification
• Patient demographic record
• Health insurance card digitalization
• Patient photo
• Patient I.D digitalization
• Document digitalization
• Integration with your Electronic Health Record (EHR/EMR)
• Electronic billing
• Delivery and reception of all electronic transactions
• Automatic audit of acknowledgments of receipt
• Automatic reconciliation
• Creation of adjustment request forms
• Monitor and follow up of Adjustments submitted
• Tools to measure productivity and collections
• Statistic reports of medical facility
• UDS table formulations for Centers-330
• Management of patient accounts receivable
• Patient collection letters