Drowning in Paperwork, Starving for Efficiency
A leading healthcare provider was entangled in a web of both physical and electronic claims challenges. Their EHR system held a goldmine of patient data but transferring it to physical CMS-1500 forms and Digital ANSI 5010 files was a time-consuming, error-prone ordeal. Each form felt like a battlefield, filled with tedious data entry, missed deadlines, and the constant threat of denials. The result? Lost revenue, frustrated staff, and a system straining under the weight of manual processes.
Breaking Free from the Paperwork and Digital Hurdles
The Client knew the status quo was unsustainable. They sought a revolutionary solution that could simplify the daily claim processing, eliminate errors, and streamline both their physical and electronic claims processing. That's where we came in, armed with our streamlined data extraction and simplified technical approach.
Mapping Magic: Seamless Data
Mapping from EHR to Claim Forms
One of the biggest challenges in the paper chase was accurately transferring patient data from the EHR system to the complex CMS-1500 forms and ANSI 5010 files.
Our solution tackled this head-on with intelligent data mapping technology. This technology automatically linked specific fields in the EHR system to their corresponding counterparts in the claim formats. Here are some specific examples of field mapping:
Field 1a: Patient’s Medicare Number: Mapped to the "Patient Medicare Number" field in the EHR system, If the claim is for Workers' compensation, then display the SSN of the patient.
Field 14: Date of Service: Mapped to the "Encounter Date" field in the EHR system, handling multiple dates for extended services if applicable.
Field 21: Diagnosis Code: Mapped to the "Diagnosis Code" field in the EHR system, using advanced logic to select the most relevant codes based on encounter details.
These are just a few examples of field mapping for CMS-1500. Our Solution used sophisticated data validation rules to ensure every form and file adhered to CMS regulations, the client's specific billing policies, and ANSI 5010 standards. Think of it as an intelligent assistant, meticulously checking each box, field, and data element before submission.
Click here for complete field mapping for both physical CMS-1500 forms and electronic ANSI 5010 submission.
Improving Care Delivery Through Automation
Manual Effort Plummeted
Manual data entry and form completion dropped by 85%, freeing up 100,000+ staff hours annually across these hospitals. Imagine the possibilities with that reclaimed time - strengthening patient relationships, focusing on strategic initiatives, or exploring growth opportunities.
Error Rates Vanished
The intelligent data extraction and validation eliminated manual errors, resulting in a 98% reduction in claim denials. This translated to millions of dollars recovered annually for these hospitals, ensuring faster reimbursements and improved cash flow.
Speed Demon Claims Processing
Claims processing time was streamlined by 70%, enabling hospitals to submit claims 2-3 times faster. This meant quicker payments, improved financial stability, and the ability to serve patients more efficiently.
Beyond Numbers
The benefits extended beyond measurable results, boosting staff morale by reducing stress and frustration. Improved financial stability through faster reimbursements enabled hospitals to invest in vital equipment, technology, and patient care initiatives.
Technology Stack
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