PRIOR AUTHORIZATION MANAGEMENT
Initiate, track, and manage medical inpatient and outpatient prior authorization requests for multiple health plans from a single site. Edit and resubmit requests as needed. Minimize costly manual and siloed processes and reduce costs.
Attach supporting clinical documentation electronically. Autofill fields with frequently used request information such as contact, referring practitioner, rendering provider/facility.
Report on prior authorization activity. Gain valuable insight into health plan prior authorization response trends and staff productivity.
ELIGIBILITY / BENEFIT AND CLAIM STATUS INQUIRIES
Determine health plan member eligibility. Response details vary by health plan but can include service level copays, specific PCP assignment, remaining deductible amounts, and other detailed benefits information.
Identify the status of a specified patient’s claim from your organization. Response details vary by health plan but can include check number, payment amount, service line payment itemization, and (when applicable) detailed denial or payment adjustment reasons.
ELECTRONIC CLAIMS MANAGEMENT
Overcome rejections, delays, denials, and any other obstacle between you and your reimbursements. Claims pass through an extensive system of edits to ensure that clean claims are delivered to payers the first time.
Powerful claims tracking feature eliminates lost claims by reporting when your claims are received, delivered and accepted by thousands of payers. If rejections do arise, the online tools allow you to research, edit, and resubmit your claims quickly. Access to ERAs from available payers is included with your Electronic Claims Management subscription.
Payer List Available Upon Request
HealthXnet Partner Services
The FIRST comprehensive and affordable HIPAA Security Rule service. We provide you with the tools, information and training that you will need to implement and comply with the HIPAA Security Rule. From primary care physicians with 2 employees, to business associates with 40 employees, to large specialists with hundreds of employees, we have priced the service so that every organization can take advantage of the benefits.
The HIPAA Secure Now! service includes: Policy and Procedures covering the administrative, physical and technical safeguards as required by the HIPAA Security Rule; a thorough Risk Assessment that looks at all systems that create, modify or maintain electronic protected health information (ePHI or better known as patient information); HIPAA Security training and compliance testing for all employees of the organization; 3 months free use of the HIPAA Secure Compliance Portal that makes it easy to manage everything that you need to achieve and stay compliant with the HIPAA Security Rule. Read more...
ENSURE YOUR PATIENTS GET THE MEDICATION YOU PRESCRIBE. CoverMyMeds® is changing the way prior authorizations are submitted in the healthcare industry. And it’s 100% free to all healthcare providers!
We’re here to help alleviate the pain of the PA process by eliminating administrative waste and more importantly, helping your patients quickly obtain their needed medication. We want your patients to get on the medication you prescribe – stay on it – and complete their therapy. Forty percent (40%) of your patients will need an alternative medication because of health plan denial. Alarmingly, 30% of prescribed patients won’t even begin their therapy due to hassles of the PA approval process. To remedy this concerning trend, CoverMyMeds has developed a solution that makes prior authorization paperless and more efficient. We have developed an electronic process that works for all drugs, and nearly all payers.