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The Next Generation in Claims Editing and Scrubbing

Unfortunately, even when all published claim filing rules are followed, providers are still likely to encounter a high rate of unpredictable denials. Veredi has finally solved this mystery by developing a methodology that captures and catalogs the unpublished edits actually used by payers in claim adjudication. The advantages to this approach are extraordinary. Say goodbye to claims that are repeatedly submitted and denied for different reasons over many months. Within seconds Pro837 reports every error in every claim needing correction. User friendly and automated, Pro837 can eliminate first pass denials! Imagine the benefit to your organization by using this predictive technology to correct claims before initial submission.

Pro837 Features:
  • Millions of edits, almost half unpublished, cover most commercial and government payers

  • Edits updated automatically every week

  • Capability to eliminate denials of eligible claims

  • Field-proven technology – tens of millions of claims scrubbed to date

  • Automated one-click electronic claims submission thru ProClaimSubmit™

  • Coming soon: Pro837 Denial Analytics Module™ will improve work processes by providing statistical and qualitative claims denial data used to identify information collection deficiencies and needed organizational improvements

    Coming soon: Pro837 interface to top institutional POMIS systems (Meditech and others) will permit edits to be performed in Pro837 and automatically corrected in most POMIS systems

    You Can Expect:
  • Accelerated cash flow

  • Up to 20% reduction in receivables

  • Up to 20% reduction in days in AR

  • Lower costs to process claims

  • Improved organizational work processes through denial analysis

  • Supported Edits:
  • All seven WEDI/SNIP recommended levels

  • Procedure coding to check for compliance with CCI policies, gender and age restrictions

  • Medical necessity using CPT/ICD9 crosswalk data and the ordering of procedures for                      maximum reimbursement

  • Diagnosis coding using valid primary diagnoses, proper levels of specificity and the inclusion          and ordering of any required accompanying diagnoses

  • Situational/conditional fields and service/procedure related fields are checked to see if they            are required and reported

  • Logical date-field relationships (e.g., date of onset occurs on or before date of service)

  • Payer-specific published rules editing (Medicare, Medicaid, commercial carriers, etc.)

  • Payer-specific unpublished rules editing

  • © Copyright 2006, Veredi, Inc.