Revenue Cycle Claims Management

Revenue Cycle Claims Management

More than a Medical Claims Clearinghouse

Facilitate rapid reimbursement through workflow automation and denial prevention tools, and collect more earned revenue with data-driven claims management.

Industry-Leading

Claims Management System

Yielding a 99.6% first-pass clean claim rate, Quadax’s Claims Management system improves financial performance and staff productivity.

More than a medical claims clearinghouse, our platform has the ability to communicate with internal billing, EHR applications and other sources of data, and provide automated workflow that tracks the claim closely throughout the RCM lifecycle to reduce errors and improve efficiency. With rules-based system functionality and alerts, problem areas are flagged and up-front edits are performed so missing or incorrect data can be corrected prior to submitting the claim. Due to continually evolving standards and payer rules, Claims Management is agile and updated in real time to ensure compliance, and to help avoid denied claims due to missing or inaccurate information.

Add To Your Resources With Automation

Xpeditor

Xpeditor—an application within Claims Management—automates workflow to quickly route claims to each biller based on client-defined criteria, and when necessary, routes claims internally to maintain an accurate audit trail to reduce the need to communicate through an external environment. Workflow automation between Claims Management and EHRs and/or billing applications result in streamlined processes that improve clean claim rates, reduce administrative costs and provide the insight and control to recover expected reimbursement with speed and efficiency.

Detect, Assign, Correct And Minimize Errors

XpressBiller

XpressBiller is a powerful rules and edit engine, designed to allow clients to build custom converts and edits they are unable to make in their hospital information system (HIS) to help detect, assign, correct and minimize errors in real-time before the claim is released to the payer.

A key component of Quadax’s Claim Management System, XpressBiller provides accurate, standard edits, plus edits custom to your organization. Quickly customize data conversions to overcome shortcomings in your claim generation routines, and enable auto-correct rules and advanced workflows to give you the greatest precision and control in your claims management.

Supercharge Your EPIC Resolute System

EPIC Claims Processing

Supercharge your EPIC Resolute System with real-time error resolution and streamlined processes.

Seamlessly integrate claims generated by the EPIC Resolute Billing system with all facets of Xpeditor into a single process, applying industry-leading Xpeditor claims management edits and rules for cleaner claims, while retaining workflow and response data in the EPIC Resolute system. No need to wait for the next batch, Quadax returns the claim validation and response almost immediately to help you increase efficiency and accelerate reimbursement.

Provide Full Transparency and Accountability

Edits & Documentation Group (EDG)

Sources and related document links are embedded within Claims Management and offer full transparency into Quadax’s rules and edit logic, policies and procedures. This includes: revision history, payer explanations and links to documentation, recent updates and custom comments—allowing our clients to leave their own documentation. Our comprehensive, up-to-date library of claim processing rules and edits are updated bi-weekly by our Edits & Documentation Group (EDG). The Quadax EDG team of experts, who are knowledgeable in both billing and ANSI claim requirements, reference nationally recognized sources, including AMA, CPT guidelines, Medicare Physician Fee and more.

Revenue Cycle Analytics

Intelligence by Quadax™

Intelligence by Quadax™ is a critical reporting and analysis solution that delivers easy access to key performance indicators (KPIs) and other measurements of financial and operational health. Components of Intelligence by Quadax™ include: Decision Intelligence, Predictive Intelligence and Data Intelligence.

Client Testimonial

Before we decided to go with Quadax for claim processing we had several areas in our revenue cycle that needed attention. With the implementation of their workflow and automation tools, Quadax was able to dramatically improve our clean claim rate which allowed us to reduce back-end denials, eliminate re-work and allowed us to reorganize our teams to become a more efficient billing office.”

— Jonathan Hendricks, Corporate Director, Commonwealth Financial Resources (MedCenter Health)

Additional Features of Claims Management

Convenient FISS Connectivity

Quickly access FISS to make Medicare claims management easier than ever.

The Quadax Portal is your gateway to a wealth of information, valuable resources and customer support, and now, your staff’s gateway to Medicare’s Fiscal Intermediary Standard System (FISS). DDE Link matches Portal files to each of your named users. Users easily log in right from the familiar Quadax Portal using their own Medicare Online System ID and password to access all of the functions they need. Integration with FISS can be quickly and easily enabled with no extra hardware required.

Electronic Claim Attachments

Support electronic claim attachment submission functionality to help free up staff resources, reduce postage costs and secure revenue faster.

More and more payers are continuing to advance with technology and lessen reliance on paper, leaving providers to keep up despite the lack of clear guidance on accepted formats or shared common standards. Between varying pre-claim attachment content such as x-rays, operative reports, ABNs, or medical records, your billing system has to support the conversion of both structured and non-structured content. With Quadax you can! Xpeditor™ supports electronic claim attachment submission functionality to free up your staff, save money on resources/postage, and helps you secure revenue even faster.

Verify Medicare and Medicaid Eligibility

Integrated Coverage Validation (ICV) communicates with Medicare/Medicaid electronic access portals to alert billing staff of missing or inconsistent details prior to claim submission.

Integrated Coverage Validation (ICV) for Medicare and Medicaid, enables Quadax to check HETS (the HIPAA Eligibility Transaction System) in real-time and before a Medicare claim is submitted, and check Medicaid eligibility in real-time with the Medicaid state. Staff can correct preventable errors up-front and submit cleaner claims the first time to avoid payment delays and extra work often required through claim follow-up. Examples include: subscriber verification, active HMO/MCO, Part A/B coverage, and MSP liability. With ICV, our clients have seen up to a 78% reduction in eligibility related denials on Medicare and Medicaid claims.

Advanced Claim Status (ACS)

Advanced Claim Status (ACS) integrates a richer and more complete claim status response into workflow to save staff time and effort and enable further automation.

Advanced Claim Status (ACS) by Quadax automates costly, manual and unnecessary follow-up tasks related to the status of claims as they move through the adjudication process. Using client-defined business rules, the ACS engine will query a claim’s status by polling the payer’s web portal with advanced screen-scraping technology to ensure the most up-to-date and actionable payer responses. Based on the responses, claims that require immediate action can be routed to the responsible party to accelerate claim follow-up. Comment records are delivered back to the EHR and/or billing application sooner so staff can work smarter.

Claims & Reimbursement Support Services

Rely on the Experts

Quadax revenue cycle experts provide routine, on-site visits to assist with event creation and resolution, continued training, reporting needs, best practices and general issue resolution. Quadax provides the perfect blend of sophisticated technology with reliable, expert, personal support.

We are at your side

Let’s take on the revenue cycle together!

Learn more about the revenue cycle solutions we offer for high-performing healthcare organizations.

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