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Although your software or billing service may produce a claim to be printed or sent electronically, it may contain countless errors. Some of these errors are caused by improper formatting, while others are created in the data entry process. Additional "rules-based" errors arise from improper CPT, HCPS, and ICD-9 coding addressed by the Local Medicare Review Policy (LMRP) and the National Correct Coding Initiative (NCCI).

Most billing software does not check for such errors and claims clearinghouses typically verifies proper formatting, the existance of codes, and other relevant information. In any case, a claim rejected by a clearinghouse, or denied by a third party, costs you money.

ClaimCorrect not only tests for the potential errors listed above, but also for Payer-Specific "rules" used by commercial insurance and Workers' Compensation organizations.

Moreover, the database engine also checks for:

• 110,000 potential bundling errors
• Global periods for Medicare and individual private payers
• State specific ICD-9 mandates
• National and State specific Medicare rules and regulations
• Modifier restrictions
• Payer-specific rules

What are ClaimCorrect's benefits?

• Can be used for all patient billing records, not just claims
• Promotes appropriate reimbursement of healthcare claims
• Reduces administrative costs
• Enables users to "prospectively" audit billing and claims
• Compatible with industry-supported claims processing systems
• Can be integrated on a variety of platforms
• Improves the accuracy of claims
• Reduces clearinghouse rejections
• Audits coding accuracy
• Extensive reporting of errors, alerts, and specialty-specific utilization reduces audit liability

You may have asked yourself, "why do I need all this technology, I'm satisfied with what I have". Because, like clinical medicine, the business of medicine is becoming more complex and technological. Why would you order an MRI or CAT scan, when a few years ago a simple X-Ray would suffice? Because advanced technology helps. This also holds true in the "back office", where every penny counts.

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