| |
Pre-Submission Compliance Analyzer™ (PCA) is a powerful
back-end application designed to validate batch files of
outpatient claims against Medicare reimbursement edits.
PCA serves as a
final safety net to insure that claims submitted pass
reimbursement edits and are more likely to be paid right the
first time. This back-end application validates
batch files of Medicare outpatient claims against the LMRPs/LCDs,
NCDs, CCI edits, CPT® codes and ICD-9 codes.
Claims are also cross-referenced against the results of
Compliance Checker™ All Payer’s activity database to ensure
procedure and diagnosis codes validated on the front-end are the
same as on the claim for the patient encounter.
Features for Standard Claim File Formats
- Reads the
file format of claim files as generated by various billing
systems
- Polls a
defined network path location to detect the presence of a
claim file to be validated, processes the file, and prints a
report identifying edit failures
- Validates
procedures and diagnosis codes against the LMRPs/LCDs
published by a defined payer
- Detects
failures against the CCI edits
- Verifies
current CPT® and ICD-9 code usage
- Compares
front-end system for presence of Advance Beneficiary Notices
(ABNs) when medical necessity edit failures occur
Benefits
- Performs
acts as a final safety net to ensure Medicare outpatient
claims pass medical necessity/CPT®/ICD-9/CCI edit validation
- Acts as an
unattended application - fast, efficient processing is
automatic
- Supplies
valuable management reports that help to identify issues to
be resolved
- Provides a
consistent source of rules for both front and back-end
validation of Medicare
outpatient order requests and related claims when used with
Compliance Checker™ All Payer
Download
pre-submission compliance analysis PDF
You might also be interested in our
medical necessity compliance solution.
View online
medical necessity compliance demonstration.
|
