Electronic Billing and Claims Management

Executive Summary

A web-based software for a clinic to get paid for the services they provide and manage their claim with the help of electronic claim submission (837 X12 formats).  Below is the list of features which facilitate the clinic to work smoother with patient account.

1.Adding charges to patient account.

2.Approving the visit for claim filing.

3.Claims can be field in 2 modes HCFA 1500 paper claims or 837 electronic claims.

4.Manage Patient Accounts, The main purpose of this section is to make adjustment on the patient account, making refunds and patient payments, there is one special module which manage the unapplied credit of the patients.

5.Manage Claims, There is a separate section where back office staff can search what is the status of the claim how many are paid and how many are with insurance payer etc. They also can see how many are rejected, what data is missing etc.

6.Getting insurance payment, there is section called EOB where billing staff can enter insurance payment by entering allowed and paid amount, the rest of the amount like disallowed and transfer balance is getting calculated and patient account gets updated automatically.

7.Easily prepare client bills and statements, what is left after the insurance payment made on the patient account is produced in the printed format, so that clinic can send it to the patient straight.

8.This s/w can run independently as well as integrated with EMR to make the PMS as complete solution, All of the information captured during a patient visit – including lab and radiology orders, procedures, and ICD to CPT coding – are all a part of the electronic patient record, and are automatically transferred to the electronic claim.

9.Billing Reports, in this s/w user can generate various types of reports, few are listed below. Productivity Report A/R details A/R Summary Report Insurance Aging Report Patient Aging Reports Claim Reports

About our Client

HealthCare Company




C#.NET, AJAX, ICD, CPT, Infragistics Components, SQL Server 2005, HIPAA, Pdf work, HCFA 1500, 837 e-claims