Getting insight from payers on billed claims is not as straightforward as a single electronic query. That’s why so many healthcare organizations use Recondo to get a real answer back instead of a mere response. Our automated tools “intelligently” request information on every aspect of claims and remittance–and our patented ReconBots™ retrieve the answers as soon as payers post them to their websites. The result? Recondo clients eliminate manual intervention on up to 90 percent of claims.
Actionable Claims Status
Business office staff frequently spend much of their work day unknowingly chasing after claims that are scheduled to be paid. Here’s a more profitable way to spend their time: on claims that actually require human intervention. Recondo’s automated ClaimStatusPlus™ tool will query and retrieve up-to-date status details on nearly your entire insurance A/R inventory. Answers from multiple payers return in a single standardized format. And unlike EDI, Recondo shows granular, payer-specific adjudication codes that tell exactly where the claim stands–and what, if anything, needs to be corrected.
Here’s the secret to revving up healthcare revenue: supercharge the business office’s workflows. And the secret to that? Route problem claims to the workers most skilled at fixing them. Recondo’s automated follow-up triggers key drivers within the business office’s workflow system of choice. For the first time ever, claims are automatically routed according to specific criteria—by review deadline, who should review it, what action should be taken, and more. This “exception-based” approach to claims processing is helping Recondo clients around the country substantially improve employee productivity and time to receive payment in full.
Revenue Forecasting and Analysis
Obtaining adjudication data from web portals within the first week after billing gives as good or better information than what is shown on remittances weeks later. It also helps healthcare organizations obtain what for years has been virtually out of reach: accurate insight within days instead of weeks or months on what will actually be paid versus what was billed.
Recondo’s automated technology presents healthcare organizations with full payment details before payment or denial, for unprecedented forecasting clarity. Denial information can be tracked on a payer-specific basis by provider, location, and service type—particularly useful trend analysis when it comes time to renegotiate plan contracts.
Electronic Claims Management
Coding complexity is a longstanding barrier to high clean claim rates. Without automated scrubbing and edits capabilities in place, expect this barrier to become insurmountable with ICD-10’s massive increase in codes. Recondo’s ClaimStatusPlus™ assures that claims are accurate and compliant before submission. Drawing from the industry’s most comprehensive collection of payer intelligence, our Claims Management tool flags errors that will result in a denial or underpayment.
It offers complete edit and submission support for all claim types, including institutional, professional, and specialty—such as DME, home health, long term care, and EMS/transportation. Direct payer connections include Medicare, Medicaid, Blue Cross/Blue Shield, TRICARE, and numerous commercial payers.