November 2005 Newsletter

Patient Advocacy

By: , VP, Systems

This year Quadax embarked on the development of a new service that we call Patient Advocacy. This service is intended to guide customers and our customers’ patients through the processes of insurance company reimbursement and appeals. The goal of this service is to get the patients’ insurance company to pay for services.

"Hey, that sounds great," you may be thinking, "but shouldn’t we be able to just send a claim out and expect to get paid?"

Well, yes in most cases. In other cases, such as new or high dollar procedures, insurance companies are very likely to deny these claims for various reasons. That is the challenge that our Patient Advocacy Service was designed to address.

We have developed new software that allows our advocates to bird-dog the insurance companies. There are several business processes that need to be worked and tracked. These processes include Benefit Investigation, Prior Authorization and management of denials and appeals. Our new software, called the Patient Advocacy System (PAS), allows the advocates to record information about these processes. Plus, it helps the advocates by guiding them with the appropriate prompts and tasks throughout these processes. These prompts and tasks can be configured at any time to allow fine-tuning of the software, without any programming changes.

PAS provides our advocates and clients with a journal of all events associated with every case. In addition, it has work queues and triggers for follow-up, unlimited contacts, integrated faxing, and image-enablement. These tools give our PAS advocates and clients a very powerful tool for dealing with insurance companies. Our advocates provide a personal touch for the patient and the physician, keeping them updated with any pertinent information.

The PAS software is web-based and secure, so that users can operate from just about anywhere. It is also very easily configured to manage these and other difficult business processes that you need to handle. If you have any interest in how this service or software can be used in your business, please contact me at (440) 777-6300.