Centralized Workflow Management automates billing rules avoiding mistake repetition. This method is far superior to relying on "common knowledge" and hoping the billers never make a mistake.

Billing rule automation enables the system to guide the operator in terms of claims that need followup. There is no need to manually look up reports to analyze data and select claims for followup. Vericle ensures followup consistency and timeliness by automatically marking claims that need followup.

As automated rules are added to the system, the accuracy of the claims increases and the billing staff can focus on handling the exception cases rather than worrying about how to bill every claim.

A centralized billing system shares its billing rules across all providers and specialties. Therefore, errors discovered and corrected for one provider will be avoided in the future for all of the providers using the system.

Centralized Workflow Management uses three key concepts, namely, workflow, failed claim, activity triggers, and workbench, dashboard.

Workflow is a sequence of actions performed on a claim until it is paid. Vericle’s rules manage the workflow for every claim with the two-pronged objective to flag failed claims and submit correct or corrected claims to the payers. Vericle documents meticulously every workflow so that we all continuously learn from past experience.

A failed claim is a claim that is flagged by the system upfront as an invalid claim, is rejected by the payer after submission, or is not properly adjudicated within 30 days -- in other words, a claim that requires followup.

In medical billing operation, followup lists constantly change. To manage multiple followup lists, the centralized workflow system has activity triggers. Activity triggers match up expectations with events and manage individual work queues in the process.

Every operator has individual workbench that presents the failed claims assigned to or selected by the operator. Denials and errors cause claims to be moved to a workbench for follow up.

The combination of activity triggers and workbenches enables workflow simplification by eliminating paper-based steps. Instead of printing, faxing, and following up with an e-mail or a phone call, important tasks arrive complete with supporting documentation.

Providers and managers use dashboards to review key indicators and focus on what is important from high-level perspective.

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