Services

Your solution for Posting Electronic Remittance Advices while enhancing your ability to recover revenue.

FEATURES of APM:

• Automates the posting of ERAs directly into the Practices billing system improving accuracy and consistency of posting and freeing up staff resources to focus on billing improvement actions.
• Eliminates EDI interfacing and file transfer demands required from conventional clearinghouse approaches to Electronic Remittance Advice processing.
• Automates posting to any Practice Management System with ability to be installed by Billing-level staff.
• Translates the HIPAA 835 EDI posting file into ICONs using a unique mapping and logic decision-making tool that resolves differences between Payor formats.
• Facilitates recovery of revenue from denied claims, by identifying coding combinations that are valid from those that are submitted incorrectly.
• Applies special keys that require correct entry before releasing the coding combination results, as a precaution against fraudulent use of the coding.
• Identifies supplemental and secondary insurance billing opportunities and facilitates practice creation and submission of supplemental and secondary insurance claims, using automated mapping to directly implement the secondary billings.
• Facilitates capture and organization of denied claim data into a “Electronic Dispute Container” that can be submitted in real-time back to the Payor, by-passing paper and mail-based resubmission processes.

Heretofore, most providers have been hesitant to adopt electronic payment / electronic deposit programs offered by Payors as there is a perception that they will lose control over the payment amount and thereby see a reduction in net realized reimbursement. Recent efforts to automate payments have focused on the bank Electronic Funds Transfer and the 835 EDI remittance advice without really addressing the “Last Five Feet” which is the final step in applying the payment and remittance information into the Provider’s Billing system and reconciling this with the bank deposit. It is hard to compete with current manual check payment solutions that involve no cost today to receive the check in the mail and ensure complete control over the posting remains with the Providers’ billing staff. VestaCare’s Automated Payment Posting Manager offers a number of significant breakthroughs in closing the gap on the “Last Five Feet”!

Highlights

• Automatically posts the HIPAA 835 EDI in real-time directly into the practice billing system without requiring any EDI translation tools.
• Maps to any practice billing system with guidance solely from billing staff
• Mapping time is typically under 4 hours
• Provides complete audit control and real-time observation allowing the billing staff to confirm and grow confident in posting accuracy.
• Savings in manual payment posting allows the billing staff to focus on revenue enhancement opportunities, e.g. correct coding, reprocessing denials, secondary and supplemental billing, thereby driving acceptance of electronic deposit.
• Eliminates all EDI complexity
• Builds a library of incorrect billing codes which can then be flagged for correction when payments are denied.
• VestaCare’s online Support Desk, “VestaChat” is available to all provider staff on a STAT basis to assist in mapping and new posting logic changes as needed.
• Issues and errors in the payment can be instantly fed back to the Payor through the VestaCare Payor network link ensuring rapid resolution and turn-around time for corrected payments.
• As an independent transaction processing agent VestaCare enables the providers to engage EDI and direct deposit services from all Payors supporting this function.

Benefits

• While there are time savings by eliminating manual posting, the biggest benefit is the ability refocus bill staff attention to correctly billing and processing denials and secondary bills.
• Providers embracing this comprehensive solution will not need to visit multiple Payor website portals to obtain payment information.  This one service supports EDI services from all Payors.
• No investment in EDI technology or IT staff resources is required.
• No change in the practice billing system software is required.
• No cost are incurred from the practice billing system vendor
• Claim Tracer mailings are eliminated to those connected Payors
• Turn-around time for processing disputes and rebilling is dramatically reduced

Providers: Automated Payment Posting Services
("End-to-End Solutions for Perfecting Payment")

	835 EDI Remittance Reception, Decomposition and Display	Tx Routing & Posting Management	Billing System Interface and Behavior Mapping	Posting Decision-making capture & Automation	Bank EFT Reconciliation	Alerts, Edits, Monitoring & Controls	Disputes, Denials Management	Supplemental & Secondary Claims identification and submission
	EDI knowledge of 835 format	Customized rules for posting	Decision-making logic	Decision-making logic	Banking practices	Decision-making logic	Claim Adjustment rules	EDI knowledge of 835 format
	Automated Payment tool	Transaction Router	Automated Smart Examiner	Automated Smart Examiner	Automated Payment tool	Automated Payment tool	Transaction Router	Transaction Router and Automated Payment tool
	Payor’s Claim system	Provider’s Billing system	Provider’s Billing system	Provider’s Billing system	Provider’s Billing system	Provider’s Billing system	Provider’s Billing system	Provider’s Billing system