Best Healthcare Claims Management Software Solutions

Best Healthcare Claims Management Solution

Hospitals & Health Systems Claims Management Solutions

Four-time winner of the Best in KLAS award for Claims Management! Achieve an industry leading clean claim rate of 99.7% first-pass acceptance with payers for fast reimbursement.

99.2% first-pass acceptance with payers

Automated & Analytics-Driven Healthcare Claims Management

A four-time KLAS award winner, Quadax’s Claims Management solution achieves a 99.7% first-pass acceptance, and facilitates rapid reimbursement, through workflow automation, denial prevention tools and data-driven claims management to help you collect more earned revenue.

Our Claims Management solution integrates with your internal billing, EHR applications and other sources of data. Automated workflow ensures claims reach billers quickly, while rules-based claim validation maximizes a claim’s likelihood of success prior to submission. Advanced reporting and analytics help you maintain compliance and uncover trends that can be utilized for greater efficiencies and maximum reimbursement.

Quadax’s talented team of RCM experts continually monitors evolving standards and payer rules so you can better utilize staff resources. Rest easy knowing Claims Management is always processing claims based on the latest rules and guidance.


Automate Claims Management Workflows

Quadax’s proprietary claims management software automates workflows to quickly route claims to each biller based on the criteria you define, and when necessary, routes claims internally to maintain an accurate audit trail, reducing the need to communicate through an external environment. Integrated workflow automation between Xpeditor™ 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.


Auto Fix and Scrub Claims with Custom Rules & Edits

The path to improving clean claim rates begins with an ounce of prevention. Prevent key issues that derail claims and reduce profits with XpressBiller. Quadax’s powerful rules and edit engine empowers you to automatically detect, assign, correct and minimize errors in real-time before the claim is released to the payer. Now you can gain more control over your revenue cycle and meet the demands of your most difficult payers without involving IT, and at no additional cost.

Intelligence by Quadax™

Revenue Cycle Analytics & Reporting

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. Real-time analytics can help your organization make more informed decisions regarding business models and monitor the strength of the organization. Components of Intelligence by Quadax™ include: Decision Intelligence, Predictive Intelligence and Data Intelligence.

Edits & Documentation Group (EDG)

Comprehensive Library of Claim Processing Rules & Edits

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 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.

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.

Eliminate the need for mailing paper records and reduce processing time by sending attachments electronically. With Quadax’s claim attachment feature, users can submit claim attachments electronically from Xpeditor™, using a simple point and click method, or send us a 275 and we can automatically match and link it to the respective claim and send automatically, barring no edits on the claim. This reduces errors and time spent sending attachments manually by mail or by fax.

Integrated Coverage Validation (ICV) for Medicare and Medicaid

Reduce Medicare and Medicaid eligibility and registration denials with electronic access portals to alert billing staff of missing or inconsistent details prior to claim submission.

With Integrated Coverage Validation (ICV), our clients have seen up to a 78% reduction in eligibility related denials on Medicare and Medicaid claims. ICV 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.

Advanced Claim Status (ACS)

Increase cost savings by integrating a richer and more complete claim status response into workflows to save staff time and effort and enable further automation.

Advanced Claim Status™ (ACS™) by Quadax is an automated solution giving you actionable claim status information sooner so your staff can work smarter! Using web-bot technology, this direct-to-payer-portal system replaces or supplements standard 276/277 ANSI transactions in order to provide a richer, more actionable data set as soon as one day post-billing. Streamline follow-up staff effort and reduce your cost to collect!

Real-Time Error Resolution in Epic

Epic Claims Processing

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.

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)

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.

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