When querying payers, how a question is asked greatly affects the answer. That’s why hundreds of hospitals and clinics rely on Recondo to ask them. Our suite of Patient Access solutions return with the industry’s most complete and current answers on patient coverage, liability, and demographics, plus real-time authorization requirements and status. And they do so within seconds instead of days.
Help your staff stay ahead of relentless patient registration volumes. Eliminate for good the registration mistakes that complicate subsequent patient access work and set the stage for claim denials. Recondo’s RegQA™ flags patient registration errors in demographic data, policy, data completeness, coverage information, and more. Watch patient access data quality improve while claim denial rates substantially drop.
Today’s revenue pressures leave little room for incorrect eligibility data. At the same time, verifying eligibility is growing more complex as patients move in and out of exchange plans. With EligibilityPlus™, providers stay on the same page with payers—literally. The tool automatically retrieves the most complete benefit detail available, from hundreds of different plans, straight from payer portals. It even combines portal data with information from payers’ EDI transactions to produce the industry’s most comprehensive view of a patient’s eligibility. As an extra measure, EligibilityPlus™ also provides intelligent alerting of denial risk.
In an era when payers are demanding prior authorization for more services, tracking their complicated requirements in three-ring binders and spreadsheets just don’t cut it. Recondo’s Auth-DP™ suite of automated authorization tools ends this inefficiency forever by bringing up-to-the-minute data to healthcare organizations instead.
AuthStatus determines whether an authorization is required and then automates the process of retrieving this information directly from the payer website. In the event substantiation is later needed, the tool captures and keeps screenshots of authorization status.
AuthInitiate verifies authorization requirement rules within Auth-DP’s 600K+ rules library for scheduled services. AuthInitiate then automates the process of logging a user in to a payer’s portal and auto-populates required data to complete an authorization request up unto the point clinical data is required to be entered by a user.
AuthSubmit addresses high-dollar denial risks—that is, failure to get authorization for services performed for direct admit patients. The tool initiates authorization communication with payers through portals and automatic faxing.
AuthNotification supports requirements based on United Healthcare and Aetna inpatient admission notification rules.
MedicalNecessity supports evaluation of medical necessity rules for Medicare and other commercial payers, and auto-generates advance beneficiary notice or notice of non-coverage.
The continued rise in high-deductible health plans calls for new collection strategies—and tools. Using Recondo’s automated patient estimation solution SurePayHealth™, patient access staff are breaking records for their healthcare organizations in pre-service and point-of-care collections. And just in time. Increased patient pay and self-pay are here to stay.
To protect revenue in this new frontier, SurePayHealth™ automates the process of calculating a patient’s liability without manual intervention, using managed care contracts, charge master data, and the most current patient benefit accumulators to create an accurate estimate. The tool even offers a financial assistance feature that aids in the financial clearance process of determining propensity to pay or charity qualification, without requiring an intrusive credit check.