Patients placed in the wrong bed status with improper documentation results in massive revenue loss and patient dissatisfaction.

Physicians can’t keep up with constantly changing criteria needed to admit patients to the hospital, and hospitals spend tons of money and resources fixing bed status issues retrospectively.

AdmissionCare provides the admitting physician with automated admission criteria - such as MCG - integrated directly into the EHR workflow to help document medical necessity that increases payer reimbursements and reduce denials.

How does it work?

• Integrate into the clinician's EHR workflow
• Determine the most appropriate bed status for each patient at admission
• Synchronize payer criteria with the clinician's documentation
• Collect revenue for the care provided, while avoiding costly denials

For providers of all kinds, managing claims and denials is one of the most demanding parts of the revenue cycle. With Waystar, you can prevent rejections and denials before they happen, automate claim monitoring, easily send batch appeals and much more. Work claims and denials within our intuitive interface or directly in the PM system or HIS you’re used to. Because implementation and integration are seamless, switching to Waystar has never been easier—or more worth it. Let’s illuminate a quicker, clearer path to reimbursement.

Payers constantly change the rules. Sift evens the playing field. Sift equips healthcare organizations to fully leverage their payments data to work smarter, protect their margins and accelerate cash.

Actionable Denials Intelligence, delivering a longitudinal view of clinical, coding, claims and remittance data. Sift establishes a data foundation that gives providers unprecedented access to their payments data and intelligence tools to better manage their denials, identify root causes and prevent future denials. 

• Unified, normalized and organized claims and remittance data.
• Delivering an accessible and complete picture of claim behavior, payer trends and the drivers of denials.
• Curated, consultative analysis pinpointing where your team can take action to prevent denials and optimize workflows.

Denials Prioritization & Intelligent Automation to better manage touches and lower the cost of delivering each dollar of cash.

• Sift’s machine learning optimizes workflows by prioritizing your team’s denial work efforts around ROI and by delivering Smart Claim Edits that improve first-pass yield. 
• Active-Learning Claim Scrubber analyzes daily claims and remittances to curate high-impact claim edit recommendations.
• Machine learning models that score denials at an atomic claim level, using over 500 attributes to determine each denial’s likelihood to overturn.
• ROI-based denials worklists seamlessly integrate into your EMR, prioritizing high-recovery denials in staff workqueues.
• Scoring that enhances existing automation capabilities, enabling the strategic automation of low-yield accounts while avoiding over-automating recoverable accounts.

Denials Prevention. By unifying clinical, coding and payments data, Sift's ML predicts denials before claims are created and provide recommendations for upstream interventions. 

Sift’s ML models predict the likelihood of denial and provide pointers for intervention and prioritized user analysis, working to optimize payment outcomes.

• Machine learning models score encounters around their likelihood of being denied, proactively flagging encounters for intervention before claim submission.
• Denial category prediction and root causes pointers enable routing to the appropriate mid-cycle workflow for mitigation.
• Mid-Cycle Denials Intelligence that ties back-end billing, denial and overturn patterns to upstream workflow data inputs to deliver root cause analysis and prevention recommendations.

Assurance Reimbursement Management is an analytics-driven claims and remittance management tool that helps healthcare financial managers efficiently manage all types of payer claims, including commercial, Medicare, Medicaid, and Worker’s Compensation, in one integrated system. Assurance provides ongoing claim visibility and supports proactive just-in-time follow-up until payment is received. Assurance Reimbursement Management gives hospitals, physician practices and other ancillary providers the capabilities to accelerate claim payment, limit denials, improve resource utilization, and reduce costs.

Denials Workflow Manager product features: - Standalone or integrated: Can be used as standalone product, or integrated with Experian ClaimSource to align claims and denials information on the same screens. - Customizable: Work lists generated based on client specifications, such as denial category and dollar amount. - Analytics: Access standard product reports, analytics reports, and forward responses to HIS/PMS systems. - ANSI reason codes: Provides ANSI reason codes and payer proprietary codes as well as descriptions.

High performing Clinical Documentation Integrity (CDI) has become the necessary link to support an increase in quality ratings. CMS guidelines affect reimbursement and change frequently. Staying abreast of changes and coding best practices is critical. If documentation isn’t complete and accurate, patient care scores and associated reimbursement can suffer. R1 CDI Solutions has a proprietary comorbidity algorithm and proven best practices that can improve documentation. By accurately adjusting for risk, the predicted rate for outcomes is more precise, enabling health systems to: ensure proper reimbursement and Medicare payments, avoid penalties, improve patient satisfaction, gain market share, and reduce clinical denials

MedData’s Denials Management Outsourcing Services improves your business office’s effectiveness by allowing it to concentrate on areas of the revenue-generating process that have a higher yield and do not distract hospital account representatives from their primary duties. We have dedicated specialists who focus on denials management nationwide with extensive experience working with ALL payer types, scenarios and denial reasons. MedData provides invaluable feedback to help the hospital improve its approach to the denial management process. We provide reports on a monthly basis (or as needed) that track payer, denial type, service, and physician’s issues. This helps our clients improve their internal processes that in turn will lead to long-lasting gains in Accounts Receivable performance. MedData works all denial types including: • Lack of Authorization • Insufficient Authorization • Medical Necessity • Unresponsive Recoupments • Coverage Exclusions • Pre-existing Condition • Coordination of Benefits • Timely Filing • Subrogation\Accident Details • All Denial types (administrative/clinical) MedData also has a dedicated focus on unresponsive patient denials (UPDs), which consist of any denial type where the patient’s and/or subscriber’s involvement is required in order to secure resolution on the claim. Our service helps prevent these denials from getting lost in self-pay and ending up in bad debt. UPDs include, but are not limited to: • Coordination of Benefits (COB) • Pre-existing questionnaires • Incident letters • Accident letters • Adding newborns to policies • Subrogation forms • Authorizations • Any other time a patient’s involvement is required by the insurer The benefits of utilizing MedData to perform your denials management is that we have the following performance drivers: • Dedicated RNs on staff for medical necessity reviews, peer to peer coordination, etc. • Primary focus on Commercial and Medicare/Medicaid claims • Strategic focus and prioritization based on dollar balance and/or potential reimbursement, age, and timely filing requirements • OCR capabilities for digitalization of hard copy remits/EOBs • Dedicated compliance team and internal legal resource with nationwide legal partnerships • We aggressively work the account until it is 100% resolved • Complete “feedback loop” to prevent future denials through a rigorous root cause analysis process • Close coordination with contracting department to ensure compliance and provide insight for future contracting • Overturn denials through the appeal processes when necessary • Incoming and outgoing call campaign with the patient • Patient texting capability • Streamlined patient letter series • Skip trace with three levels of escalation

Processing insurance claims can be a labor-intensive task, involving extensive documentation, data entry, and manual effort. CampTek has an Intelligent Automation solution will do the following things:

• The integration of AI identifies problematic payors and claim types. These types of issues can be remediated via System configurations or through automation.   
• Larger more repetitive workflows can also be automated at scale.  
• This an end-to-end solution can be implemented to solve the issues with a claim before it is submitted but also as a continuous improvement of workflows.  

Automated Data Extraction and Transmission:

It will automate the extraction and transmission of data related to the insurance claim in any EHR/EMR, payor portal and clearing house. 

Unstructured data, such as handwritten notes or scanned documents, can be automatically extracted and organized and entered into an EMR/EHR, ERP System, payor portal or clearing house website. It’s accurate and consistent.  

Average Annual KPI’s for a Provider with $3B Annual Net Patient Revenue:

• Efficiency and accuracy increased by 48% 
• Accelerates reimbursement by 38% 
• Reduces rework and denials by 30% 

Alpha II delivers revenue integrity by enabling proactive denial intervention throughout the revenue cycle. We empower precision through coding, compliance, claims editing, quality reporting, and revenue recovery analysis. Our clients and partners include professional and acute care providers, clearinghouses, billing services, payers, government entities, consultants, and other healthcare software development companies. Serving a broad variety of clients allows us to hone the functionality, design, value, and effectiveness of our solutions with provided experience and insight.