A host of complex decision-making situations have been captured to create new automated workflow applications. These applications become stand-alone or integrated components of a larger, enterprise or end-to-end automated process.
Each innovation was derived through a process of consulting experts from VestaCare’s claims payment automation team working with client billing and posting personnel to identify, capture human-decision-making, map, test and deploy the following sample applications. By bridging the clients expert knowledge of practice billing, coding and payment analysis with VestaCare expertise in Human-decision-making automation, the client’s knowledge base has been codified into solutions that create significant operational value, enhanced human productivity and secured retention of their unique process knowledge for years to come. In addition,the development and exchange of “Best Practices” between VestaCare’s users further enhances the value contribution between clients.
Providers: Innovative Automated Payment Posting & Decision-making Applications
("End-to-End Solutions for Perfecting Payment")
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Business Rules and Alerts controlling Posting Acceptance: Simply passing an EDI 835 file does not provide Physicians with all the details needed to monitor, accept and reconcile the payment. VestaCare’s process synchronizes Funds Deposit Notifications (FDNs) from Banks with the posting process, eliminating EFT payment reconciliation burdens. |
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Identification of Supplemental & Secondary Billing Opportunities: Coordination of Benefits with multiple plans is included in the details provided by the VestaCare Automated Payment Posting process. |
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Denial Claim Charge Coding Review & Correction: Reason codes associated with declined claims will be automatically interpreted and loaded into the provider billing system as the payment is posted. Flagging denied charges for corrections of procedure or diagnosis codes strengthens the ability to recover revenue from valid charges. VestaCare’s claim payment posting includes scrubbing of the data compared to outstanding invoices, synchronizes the data and is capable of making a claims data correction. |
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Disputes Submission Automation: VestaCare’s electronic submission of payment provides a mechanism to dispute a claim payment and send back the dispute reason and details to the Payor, improving the turnaround time associated with this type of communication. |