Does Your Claims Management Vendor Check All The Boxes?

June 14, 2022 By: Quadax

Essential questions to ask to ensure rapid reimbursement. 

The financial health of your organization hinges on your ability to capture reimbursement quickly and completely. You cannot afford delays due to inefficiency or inaccuracy so one of the most important things you can do when evaluating a claims management vendor is to ask the right questions. 

Inefficient communication between billers and coders can add days to claims submission, delaying payments. Process-based performance indicators that many vendors tout include first-pass rate (the percentage of claims entering adjudication on the first submission); reliability (measured in system uptime); and transmissions frequency. The variance in the statistics for these measures may be small; however, when the differences are considered according to the reimbursement value of the claims at stake and the potential for delays to compound, it’s clear that every percentage point matters.

Our Claims Management Checklist outlines what essential questions you should ask, and the answers your vendor should provide, so you can match up your expectations to their capabilities, gaining a clear understanding of what their solution can (or cannot) deliver. For example:

Functionality  Questions to Ask Vendor
Remittance Splitting Can you split remittance files by invoice number/patient control number, Payer or Tax ID?
Medicare Coverage Validation Does your solution have the ability to automatically identify when a managed-care plan should be billed instead of Medicare?
Implementation and Service

Do you come on-site to manage the implementation? Do you provide dedicated resources, including monthly visits, training new-hires and improving billing team performance?

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Increasing financial pressure related to changing healthcare economic realities requires the pursuit of continuous improvement and streamlined productivity. Because of this, it is more important than ever to partner with a high-performing claims management solution. 

A four-time KLAS award winner, Xpeditor – the Quadax Claims Management application –  achieves a 99.6% first-pass rate, and facilitates rapid reimbursement through workflow automation, denial prevention tools and data-driven claims management to help you collect more earned revenue.

Your vendor should be your partner, helping find ways to make your organization more efficient and successful. We work hand-in-hand with clients to identify areas we can automate, then put those plans into action.

We’d love to talk to you, to understand your goals and share how we can help you meet or exceed them. 

Let’s take on the revenue cycle together!

 

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