CLAIM VERIFICATION SERVICES

InstaMed's Claim Verification Services provide immediate responses so you can detect claim errors, reduce the risk of compliance issues and ensure accurate reimbursement before claims are submitted to Payers. Real-time processing and pre-adjudication for all claims. Accept real-time and batch inputs. Receive real-time responses integrated into your workflow prior to submission.

Clinical Coding Verification Service - Best of breed clinical claims scrubbing in real-time. Receive responses in standard X12 response format or human readable reports. Configurable filters invoke on per claim basis, based on procedure codes, total charges, provider and payer.

Eligibility Verification Service - In-stream, real-time eligibility verification before claim is submitted. Receive responses in standard X12 response format or human readable reports. Configurable filters invoke on per claim basis, based on procedure codes, total charges, provider and payer.

Level I - Includes real-time HIPAA validation, payer edits, delivery to payer, acknowledgement and payer status.

Level II - Includes Level I plus Clinical Coding Verification Services (CCVS) which provides clinical scrubbing including National Coverage Determinations (NCDs); Correct Coding Initiative (CCI) and Medical Necessity edits.

Level III - Includes Level II plus Eligibility Verification Services (EVS).

Integration & Reporting - Many formats and integration methods are available for claims and responses; all levels include robust web-based reporting and query capabilities.

• Increase collections and receive full, accurate payment
• Capture missing procedure codes and additional revenue
• Accelerate cash flow
• Cut costs by reducing rejections which reduces your staff's time to rework claims
• Verify eligibility prior to claim submission
• Ensure payment accuracy, timing and reconciliation
• Detect claim errors, rejections and potential denial issues prior to submission
• Reduce compliance risk by reducing your exposure
• Easy to use and understand responses
• Define your own views, workflows and reporting
• Define your own business rules as part of your workflow
• No system changes - InstaMed can work with your existing systems and vendors or carry your transactions

FEATURES

• Patient eligibility
• Missing or invalid CPT Code
• Invalid modifier w/ CPT
• Invalid modifier w/ other modifier
• Modifier 25/26 required
• Rebundle to appropriate procedure code
• Unbundled Procedure
• Unbundled E/M services
• New vs. Established patient
• Established vs. New patient
• Patient age not valid for procedure
• Anesthesia performed by non anesthesiology provider
• PT Gender missing or incorrect
• ICD code invalid or missing
• Diagnostic test in hospital setting
• Post-op unrelated service
• Place of service not typical
• Missing or invalid place of service
• Medicare Unrelated surgery
• Medicare Unbundle

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• For more information: Click here to download the Claim Verification Services (PDF)

• Click here for Implementation Questions

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