Automated Claim Status
DaVincian’s Pre-Adjudication Claim Management system is a standalone solution that helps hospitals and health systems automatically follow up on submitted claims. This saves hours on follow-up time, allowing staff to focus on more productive activities.
The Pre-Adjudication Claim Management solution is typically the first step in DaVincian’s Challenger™ workflow automation system. It receives and processes the ANSI 997 and 999 acknowledgment transactions, as well as 277 unsolicited claim status transactions that get generated by payers and clearinghouses in response to electronic claim submissions.
Using highly customizable business intelligence rules, the system will automatically submit 276 claim status transactions to payers using payer-specific rules established by the hospital, regarding timing and frequency. This solution enables hospitals to track 837 claims all the way from submission to full adjudication.
The rejection reasons in the 277 claim status transactions are mapped to coincide with standard rejection code groups. Once intelligent workflow is in place, hospitals can route rejections to the right people, at the right time.