Claims Editing
As part of the adjudication process, payers must edit claims to determine that they were properly coded. In the past, claims editing was a slow process that vetted, and often denied, claims based on proprietary edits developed by the editing vendor.
In contrast to the legacy editing systems, ConVergence Point offers payers and their providers an extremely flexible, fully transparent editing and analytics solution based on open-sourced rules and a SaaS technology platform that dramatically improves adjudication rates and provider relations, while containing costs.
ConVergence Point edits claims in sub-second real-time, across total patient history and payer specific reimbursement policies anywhere in the claims stream — including pre-adjudication — and with any transaction system or interface.
ConVergence Point can be customized to exactly match a payer’s reimbursement policies. This increases auto-adjudication rates as fewer claims have to pend.
ConVergence Point Clinical Editing Highlights:
- Increased savings — an additional 2-5% above current editing system
- Improved provider relations with access to edit sources for providers through portal
- Fully open-sourced edits from sources like CMS and the AMA
- Increased auto-adjudication and first pass rates as less claims have to pend
- Unmatched insight into operations with claims analytics and data mining from 80 terabyte data warehouse