ImpactMD ClaimEditor

The Next Generation in Claims Editing and Scrubbing

Unfortunately, even when all published claim filing rules are followed, providers are still likely to encounter a high rate of unpredictable denials. ImpactMD has finally solved this mystery by developing a methodology that captures and catalogs the unpublished edits actually used by payors in claim adjudication. The advantages to this approach are extraordinary. Say goodbye to claims that are repeatedly submitted and denied for different reasons over many months. Within seconds the ImpactMD ClaimEditor reports every error in every claim needing correction. User friendly and automated, our Claim Editor can eliminate first pass denials! Imagine the benefit to your organization by using this predictive technology to correct claims before initial submission.

ClaimEditor Features:

Millions of edits, almost half unpublished, cover most commercial and government payors

Edits updated automatically every week

Capability to eliminate denials of eligible claims

Field-proven technology – tens of millions of claims scrubbed to date

Automated one-click electronic claims submission.

You Can Expect:

Accelerated cash flow

Up to 20% reduction in receivables

Up to 20% reduction in days in AR

Lower costs to process claims

Improved organizational work processes through denial analysis

Supported Edits:

All seven WEDI/SNIP recommended levels

Procedure coding to check for compliance with CCI policies, gender and age restrictions

Medical necessity using CPT/ICD9 crosswalk data and the ordering of procedures for maximum reimbursement

Diagnosis coding using valid primary diagnoses, proper levels of specificity and the inclusion and ordering of any required accompanying diagnoses

Situational/conditional fields and service/procedure related fields are checked to see if they are required and reported

Logical date-field relationships (e.g., date of onset occurs on or before date of service)

Payor-specific published rules editing (Medicare, Medicaid, commercial carriers, etc.)

Payor-specific unpublished rules editing