A post-pay review review is intended to accurately
identify and recover overpayments to physicians, hospitals, and other providers.
In an effort to control costs, a payer or a contractor for a payer may request supporting
medical information such as admission records, physicians’ notes, and pharmacy records.
eSolutions’ Appeals Manager can help you manage
the entire audit trail of a post-pay review. You can keep track of your contacts
with the payer and within your organization, including generating and attaching
documents, routing the claim, and requesting follow-up. With Appeals Manager, you
can identify areas of weakness and develop a comprehensive plan to prevent further
issues.
- Intuitive interface
The tabbed layout displays all notes and attached documents in a simple-to-navigate
workflow. You can view the entire process – reason codes, descriptions, and follow-ups
– so you know exactly which documentation will need to be collected.
- Improved workflow process
Stay organized by easily adding notes for yourself and for others as the request
moves through the workflow.
- Full integration with other management tools
For Medicare related post pay reviews, you have full patient and claim information
from MedicareSAM. This integration provides a complete audit trail while also showing
you the claim’s exact status and location in the Medicare FISS system.
- Reduced labor costs
With an efficient system in place, you’ll be able to do more work with fewer staff
members. You’ll have:
• Improved appeals management process
• Appeal notes integrated to host system
• Support for workflow and individual or group assignments
• Prioritization of follow-up tasks
• Unlimited users
eSolutions’ Appeals Manager is the simplest and most efficient way to manage your
post-pay review process. Decisions that need to be appealed are automatically loaded
in to work queues, making follow-up simple.
With Appeals Manager, you get in-depth outcome analysis, auditing, and productivity
reporting. It also offers integrated appeal notes to your host system and its comprehensive
reporting and notes tools give you updated claims status. Appeals Manager is easily
integrated with your current business processes and allows for unlimited users so
you can complete individual and group assignments in the most efficient way possible.
Appeals Manager starts by pulling in claims from our ERA Analyzer tool. From here,
it’s simple to begin a new workflow for the review request.
Because the review is taking place after the claim has been adjudicated, the complete
adjudicated claim information (i.e., Adjustment Reason Codes, Remark Codes) is included
as well. Appeals manager will also allow you to route the claim or request follow-up.
Successful management of your post-pay review workflow is essential The advantage
with Appeals Manager is that you can make absolutely sure that each step
of the post-pay review has been completed. Often, health care providers are faced
with a challenge when the process becomes too time-consuming or when they lack the
required staff resources. Appeals Manager eliminates both of these problems!
While specific computer hardware and type of Internet connection play a significant
role in how fast or slow any Web application works, Appeals Manager can be used
on virtually any system, regardless of the type of Internet connection you have.
Appeals Manager is a completely Web-based service that is billed on a flat monthly
rate. eSolutions establishes the rate based on the size of your organization, making
our solutions cost-effective for all providers. Contact eSolutions for a cost-of-service
estimate for your facility.
Request more information on Appeals Manager and start your free trial today!
|