15 individual tools that can streamline and simplify your claims processing

Other types of businesses have a luxury they don’t even realize. They render a service or provide a product, then charge the customer or client for it. The client/customer pays them and the transaction is complete.

In the healthcare world, it’s more complicated. Money usually doesn’t change hands directly. Instead, healthcare organizations have to work alongside insurance carriers to collect the payment they need.?

For any company operating in the healthcare industry, claims processing can be burdensome. It requires time, energy, and attention to detail. Without it, though, your business can’t bring in the revenue it needs to thrive.

Now, here’s the good news. Claims processing can be easier than you might imagine thanks to new tools and solutions. Here at Key Software, Inc., we’ve spent years developing a wide range of products supporting the many aspects of the healthcare claims processing lifecycle. In fact, we have 15 individual tools that can streamline and simplify your claims processing.?

Solving your claims pain points

Specifically, we offer:

• Keystone Electronic Data Interchange (EDI) Pre-processor: This solution both loads in and validates EDI files from more than 40 health plans in various formats (e.g., X12, proprietary formats). At the same time, to help you avoid using default IDs, it gives you the ability to create members and providers on the fly, leveraging data from both claims and the National Plan & Provider Enumeration System (NPPES).?
• Keystone EDI Claims Viewer: Do you ever wish you could get an organized, claims-centric bird’s eye view of your EDI data? This tool delivers. You can use it to view, validate, and modify EDI data in a user-friendly way.?
• Keystone EDI Claims Generator: Remove a manual task from your to-do list. This solution exports data in various EDI standard formats.
• Keystone Claims Capture: Trying to go digital? This tool converts Health Care Finance Administration (HCFA-1500) and Unified Billing (UB-04) legacy paper claims into a digital format so you can load them into your claims adjudication system.?
• Keystone B11 Claims Redirect: Don’t let misdirected claims slip through the cracks. The solution catches and reroutes them to the right place, whether that means generating a paper claim or an X12 EDI response.?
• Keystone Claims Workflow Engine: This solution supports your workflow. It allows you to define and configure your process, then ensure claims travel through it for optimal accuracy and completeness.
• Keystone ERA Reconciler: Automatically track every single line item within EDI 837 claims and EDI 835 remittance files with this tool. It accepts matched items while highlighting any mismatched lines, flagging them for your attention so you can drill down and reconcile any claims that need it to improve cash flow and revenue.
• Keystone Claims Auto Adjudication: Simplify your adjudication with this tool that applies your specific business rules to automate the process. With it, you can adjudicate claims in batch or real-time mode, achieving an automation rate of more than 85%. This, in turn, can help you adjudicate more than 50,000 claims an hour.?
• Keystone Claims Audit: We designed this solution to perform payment integrity checks. It can look for things like duplicate checks and overpayment, simplifying your compliance audits. It also flags claims for manual audit and re-audit, helping you to ensure payment processing and compliance.
• Keystone Bundler/Grouper/Pricer API: Let this tool perform inpatient, outpatient, and ambulatory surgical center (ASC) claims bundling for you. It can bundle before or after claim loading and interface with 3M, Clinical Coding Expert, and MicroDyn EncoderPlus (APC, MS-DRG, ASC, APR-DRG) Grouping and Pricing.
• Keystone CMS Encounter Management System: Use this to manage the collection, submission, and tracking of encounters to the Centers for Medicare & Medicaid Services (CMS).
• Keystone Claims Datawarehouse: Bring all of your claims — and all of their supporting data — into one solution to enable predictive analysis and examine things like claim-denial trends, payer performance, and more.
• Keystone Provider Outreach Management Solution (POMS): Use this tool to automatically generate provider outreaches through websites, phone, email, fax, and mail while also managing inbound responses.
• Keystone EOB & EFT: Post-decision, this solution automatically generates electronic fund transfers (EFTs) and explanations of benefits (EOBs).
• Keystone Provider Dispute Resolution (PDR): Let this tool handle appeals, re-opening, reconsideration, and peer-to-peer requests for payment adjustment while enforcing regulatory turnaround times.

Getting started with simpler claims processing

If you want to explore what our Keystone claims solutions can do for you, don’t hesitate to contact our team today.?