More about Healthcare Providers

Healthcare Providers enlist PCH as their cost containment solution for administrative issues from the initial stages of checking eligibility and requesting authorization to analyzing and taking action on underpayment issues at the end of the process.

At the front desk, PCH provides a platform for easy access to patient records and enables demography and charge rate entry. After the visit, PCH manages unstructured EHR, produces accurate coding, and submits claims to the Payer. Once the claim is submitted, PCH manages denials, posts payment, manages AR, handles calling and collections, analyzes underpayment issues, as well as printing and communication.

PCH is a unified portal that connects Providers to Payers and Members for efficient management of claims that allows full visibility at each stage of the claims process accompanied by trackers, reports, and alerts. It enables easy communication between the entities involved in an end-to-end process. PCH significantly reduces cost and improve revenue by simplifying the administrative efforts involved in the claims process.

How IT Works

Medical Coding & Audit

  • Customized Coding & Compliance Audits | Consistent Rules updates for Computer Assisted Coding (CAC) & Auto Coding | Claim checked against contract database for optimal billing

Claim Submission

  • Single channel for Paper & EDI | Data verified and pre-claim edits → Clean-claim | Real-time notification & visibility of any deficiencies & status of claim | Client-specific Validation

Lockbox / Payment management

  • AP / AR Management | ANSI 276/277 Process Enabled | ERAs for Auto Posting / Reconciliation

Revenue Integrity

  • Underpayment identification and Recovery | Dashboards and solutions driven reports by Big Data analytics | AR Management | Online Re-submission option

3rd Party/Bad Debt Collections

  • Consolidation & Tracking of all payments within workflow

Unified Communication Services

  • Presentment | iCRM |Live or Virtual Agent Patient Outreach & Follow-up | FAQ Print & Mail - Claim,EOB, Correspondence| Alerts & Notifications

Storage/Archival

  • Active Record Management | FlexiblePhysical Delivery Schedule |Scan on Demand | Online Ordering | Inventory Control

PAYER

Provider

Claim Submission

  • Single channel for Paper & EDI | Data verified and pre-claim edits → Clean-claim | Real-time notification & visibility of any deficiencies & status of claim | Client-specific Validation

Lockbox / Payment management

  • AP / AR Management | ANSI 276/277 Process Enabled | ERAs for Auto Posting / Reconciliation

Revenue Integrity

  • Underpayment identification and Recovery | Dashboards and solutions driven reports by Big Data analytics | AR Management | Online Re-submission option

3rd Party/Bad Debt Collections

  • Consolidation & Tracking of all payments within workflow

Unified Communication Services

  • Presentment | iCRM |Live or Virtual Agent Patient Outreach & Follow-up | FAQ Print & Mail - Claim,EOB, Correspondence| Alerts & Notifications

Storage/Archival

  • Active Record Management | FlexiblePhysical Delivery Schedule |Scan on Demand | Online Ordering | Inventory Control

Member Enrollment Services and Healthcare Exchanges

  • Quote to card | Secure, web-based plat form for effectively managing healthcare enrollments and documentation |Member Installation

Medical Coding & Audit

Coding Support

Remote or Onsite | Domestic & International Services | Experienced with all systems | Electronic Records | Scanned Images | Hybrid Systems | Temporary or Full-time Support | Workflow Management | 3M Preferred Partner | Improved Coding Integrity | Reduced Backlogs & Rebilling

Audit Services

DRG Audits | Outpatient Audits | Comprehensive Code Validation | Specialty Audits

Provider Coding Support

Remote or Onsite | Domestic & International Services | Experienced with all systems | EMR, Scanned Images, or Hybrid Records

Provider Document Integrity

Customized Physician and Non-Physician Training | Education on ICD-10 Specificity Concurrent Medical Records Review

ICD-10 Solutions

Seamless ICD-9 to 10 Transition Support | Prepare Staff on Training & Documentation | Update Documented Audit Control Procedure | Reduce Uncertainty & Eliminate Collections Impact |Optimize Revenue using Big Data Automation | Coding & Compliance Audits | Documentation Improvement

Credentialed Staff

Regular Quality Reviews & Accuracy Assessments | Continuous Education | No Subcontractors | Dedicated Facility Account & QA Managers | RHIT | RHIA | CCS | CCS-P | RN | CPC | CPC-H

Claim Submission

Intake – Paper & EDI

Complex Claims Formats | PO Box | Upload | Print Driver Intake | Direct Data Entry | Fax | Email | Mobile Apps | EDI

Capture & Extraction

OCR | Exception Handling | Indexing and Classification | Skip or Key Process | Quality Assurance | Doc Typing Routing

Decisioning

Rejection Management | Denials and Re-pricing Routing | Images, ANSI 837 | FTP Loading | Customer Interaction Management.

Edits

Configurable Business Rules | Client-specific Validation | Auto & Manual Corrections.

Dashboards and Intelligence

TAT Report | Audit Report | Aging

Presentment

Configurable Composition & Editors | Automated Content Generation | Print & Mail | Electronic

Servicing

Payment Hub | Lockbox | Collections Customer Interaction Management

Archival and Retrieval

On Premise and/or Cloud Hosted | Security & Compliance | Redundant | Amendment Tracking | Summarization & Dashboards

Lockbox / Payment management

AP / AR Management | ANSI 276/277 Process Enabled | ERAs for Auto Posting / Reconciliation

Payment Channels

Smartphone/Tablet | SMS | Auto-pay | One-time Cash Payment Remittance | ACH | Online Portal

Bill Payment

Bill Payment | Check Authorization |Check Image Processing | Auto-adjudication |Collections | Multi-level Approval

Proprietary Technology Platform

Configurable Business Rules | Process 27 Types of Simple & Complex Claims | Same Day Turnaround Time | Deployed in NIST – DoD | Certified by ‘AppSec’

Finance & Accounting

Invoice Consolidation | Expense Management Cash Flow & Liability Visibility | Real-Time Tracking | Revenue Forecasting | Departmental Accounting & Payment Options

Presentment

Print & Mail | E-Bill Distribution | Standard Forms | Document Composition | Targeted Marketing | Branding

Exceptions Management

Reconciliation | Misdirected / Incomplete Payments | Transaction Auditing

Revenue Integrity

Contract Management

Foundation for All Services | Expected Reimbursement Contractual Allowance | Technology Based Platform | Business Rules Based Engine Table Driven Architecture Load, Maintain All Payer Agreements | Data Mining and Analytics | Ensures compliance

Shadow Client System

Calculation Adjudication Engine | Expected Reimbursement | Contractual Allowance | Supplement, Compliment Client System | Daily Comparison | Eliminate False Positives Identify Areas of Risk

Predictive Modeling

Measure Revenue Impact of Contract Terms Develop Market Specific Strategies |Utilize Historical Claim Data | Benchmarking | Rate Comparison and Setting | Multiple Scenarios | Monitor Payer Contract Performance

Underpayment Services

Identify and Recover Underpayments | Retrospective, Concurrent | All Payer All Products | 2%- 5% Unrecognized, Unrealized Revenue | Root Cause Analysis | Hold Payers Accountable |Avoid Timely Follow-Up Limitations, Penalties

3rd Party/Bad Debt Collections

Services

Ambulance(ground and air) – servicing since 1987 Physician Practices – servicing since 1987 Hospitals – servicing since 2002 Retail Vision Centre's – servicing since 2008 Medicaid Reclamation – servicing since 2008 Pathology Labs – servicing since 2010 Medical Supplies – servicing since 2013 Telecom – servicing since 2000 Government Services – servicing since 1997 Financial Services – servicing since 2000

Segments

First Party | Post Cancel | Pre collect | Primary Secondary | Tertiary Warehouse Email Web chat | Customer Service.

Compliance

FDCPA | HIPAA | TCPA | PCI DSS | GLBA | ECOA | FCRA | UDAAP | SCRA | SSAE 16

Unified Communication Services

Customer Interaction Management

Natural Language Processing | Live or Virtual Agent | Billing | Scheduling | Q&A | Support | Request | Complaint

Composition

Document Design | Interactive Web Tools | Real Time Production | Custom Data Integration | Automated Segmentation & Dispatch Configuration

ePresentment

Electronic Bill Pay & Presentment | Targeted Marketing | Welcome Packages

Print & Mail

EOB Correspondence | Checks | Statements Marketing | Disclosures B/W | High-light | Full Color | Skip Tracing | Return Mail

Outcome Resolution

Payments | Routing | Disputes | Rebates

Alerts & Notifications

Internal | External | Trigger Configuration | Threshold Monitoring | Reminders | Calls to Action | Tracking

Storage/Archival

Real-Time Data

Live Enterprise Data Feeds | Version Control | Upload Notifications | Cloud Collaboration | File Previews | Automated Form & Content Classification

Radiology Archival

Physical or Electronic | NARA Certified Facility | Analog Film Library Storage & Management | Scan On Demand Film Digitization | Mammography Scanning | Secure Destruction

Flexible Implementation

Rapid Third Party & Legacy System Integration | Individual or Enterprise Registration | Smartphone & Tablet Apps | Any File Type | OS Agnostic | Subscription or Monthly Billing

Profile Management

Define Permissions, Roles & Access | Bulk User Actions | Drag and Drop Uploads | Activity Tracking | Desktop Sync | Self Help & Multi-channel Support

Security & Compliance

Secure and Multi-industry Compliant Storage | Anti Breach Architecture | User Security Controls |2-step Verification | Encrypted Security Tokens Remote Wipe | Shared File Expiration

Actionable Intelligence

Data Aggregation & Analysis | Configurable Dashboards | Threshold Monitoring | Alerts & Notifications | Unified Communication Services

7210

Providers on our platform

600+

AHIMA certified coders

$1.5 B+

Underpayment identified and recovered

Coding Leader

KLAS 2014 Ranking

HEALTHCARE VALUE ENHANCERS

RHIT, RHIA, CCS, CCS-P, RN, CPC, and CPC-H credentialed staffs

ICD-9/10 solutions, migration and training support

Flexible solutions including onsite and remote coding & auditing capability

Effortless claims management with status tracker and reports

Lockbox and AR management ensure the faster cash flow

Revenue integrity solution for accurate revenues and maximize the revenue

Highly secured record management facility to store medical records

Efficient collection process made collection quickerwith less cost

Integrated unified communication services to get informed throughout the life cycle of the process

  • Live Support

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