• Electronically scans and imports record request data from requestor letters
• Automatically checks if claim was previously requested or excluded from audit
• RAC Site Monitoring and Data Collection
• FISS System Monitoring and Data Collection
• Commercial portal monitoring, data Collection and Document Submission
• Pre-Bill Audit tracking and support

AuditNavigator™ Reporting

• Activity dashboards
• Financial in-process reporting
• DRG revision
• Data integrity analysis
• Recovery rate
• EHR status report
• Request status summary
• Claim issue listing
• Appeal status
• Management summary
• Ad hoc Reporting

DenialsNavigator™

• Rules based denial triggering engine with the ability to set rules based on 18 variables
• Sophisticated and flexible Workflow design
• Automated Workflow and work list assignment
• Ability for multiple users to work on a single claim based on Reason code simultaneously
• Set triggers based on Primary vs Secondary payer
• User defined Actionable vs Nonactionable and Technical vs Clinical reason Codes
• Interface with Cerner, Epic… for return notes
• Supports denials at the header and line level
• Utilizes facility defined tables
• Facility defined reason code reporting categories

DenialsNavigator™ Reporting

• Denial dashboards
• Root cause analysis/department/disposition
• Payer denial analysis
• Denial reporting by Group Codes
• Recovery/Denial/KPI trending
• Corporate level rollup reporting for multi facility, clinic and physician group entities

Shared Modules

• Tracking and Management
  • User configurable (payers, audit type, events, issues, time frames, custom fields)
  • User-specified workflow (tasks, responsible person, alerts)
  • Appeal Type Sensitive Workflows (medical necessity, coding, etc.)
  • Historical claim database for easy data entry (up to 4 years of claims history)
  • Retrieve data from claim history database to minimize data entry
  • Task work list by user
  • Document repository (upload and attach document in pdf, doc, xls format to request or claim)
  • esMD –Electronic Medical Record Submission to participating CMS contractors (MAC, RAC, etc.)
  • Electronically transmit medical records, appeal letters and correspondence via efax, payer portals, secure email and SFTP
  • Attach comments to request or claim
  • Appeal letter templates populated with data from system database
  • Task status dashboard with drilldown to individual claims
  • Generate CD/DVD containing requested medical records
  • Supports most all audit/appeals types (Commercial, RAC, Medicaid, CMS, ZPIC, ADR, PrePay, etc.)
  • Pre-Bill Audit tracking and support

• Executive Health Resources
  • Electronic Document and Information Exchange – Platinum Level Approved for all EHR appeals
  • Auto-populates EHR required documents
  • Automatically updates document status from EHR system (appeal levels, denials, etc.)

• Reporting
  • Activity Dashboards
  • Financial In-Process Reporting
  • Summary by DRG
  • Data Integrity Analysis
  • Denial Recovery Rate
  • EHR Status Report
  • Request Status Summary
  • Claim Issue Listing
  • Appeal Status
  • Management summary
  • Ad hoc Reporting

• Automated Interfaces
  • Populate provider system with AuditNavigator™/DenialsNavigator™ data
  • Receive accounting, contract and medical coder data from provider system