Claims Processing Services
SourceHOV | Healthcare’s Claims Processing solution represents a highly integrated front-end claims process that delivers 100% digital claims submission — significantly reducing administrative costs, improving auto-adjudication rates and dramatically reducing turnaround times.
SourceHOV | Healthcare processes more than 500,000 claims daily and has extensive experience in converting all types of claims forms, including CMS-1500 and UB04 (Single / Multi / Attachment / COB), RX claims, Medicaid, Foreign claims, Superbills, Medicare, Medicaid, Dental, and Vision claims.
Non-standard paper claims can be converted once identifiable rules and procedures for conversion have been defined by our client.
We improve the quality of data received and enhance internal throughput times using our unique systems interface with client membership and eligibility tables.
We improve our clients’ first pass rates and facilitate the correction of upfront errors, resulting in reduced client labor expenses.
Claims Entry and Validation
Our products are able to make significant use of client-provided membership and eligibility tables to increase both quality and throughput. SourceHOV currently processes more than 650,000 client claims per day (over 100 million healthcare claims annually) through our data extraction, verification and workflow enabled processing.
We use context-sensitive spell checking, increasing accuracy and reducing validation operator interaction. Our databases not only validate fields on a form, but can automatically fill partial records with complete data. We can customize all standard and nonstandard databases to reflect the demographics of each client or claims site.
Paper Clearinghouse (PCH)
Designed to bridge the Payer and Provider divide and close the revenue cycle gap, SourceHOV’s proprietary platform allows physicians and hospitals to submit all claims, whether paper or EDI, to all payers through a single web portal. For the Payer, PCH reduces overall Per Member per Month (PMPM) operating expenses with primary impact on mailroom, call center, and correspondence areas. PCH increases the EDI submission and auto-adjudication rates and improves claim payment financial accuracy.
SourceHOV | Healthcare is the world’s second largest user of IBML high-speed scanners. Nationally, we scan over 6 million images per day.
Optical Character Recognition/Intelligent Character Recognition (OCR/ICR) Processing
The applicability of OCR/ICR platforms can vary by client and industry. Most of our Healthcare Payer customers’ workflow solutions incorporate multiple OCR engines in a voting arrangement, allowing SourceHOV to take best advantage of each process and its particular strength.
To improve first pass approval rates, SourceHOV performs a claims validation step prior to client transmission similar to a Level 1 adjudication process. With estimated adjudication processing costs of $350 per claim, improved first pass rates result in dramatic cost savings for our Healthcare Payer clients.
SourceHOV EDI services offer a combination of data editing and scrubbing tools, web-based claims processing as well as consulting and programming services. We provide an enterprise wide gateway for both paper and EDI transactions in order to improve edit capability prior to adjudication. Our payer clients still have flexibility regarding their preferences to receive and submit claims and simplify connection points.
Our EDI services add to your processing efficiency by migrating claims correspondence from paper to e-documents and from e-documents to EDI. We use an edit-based gateway to identify rejections early, identify attachments proactively and auto-correct submissions. And we can use “print-to-file,” “fax-to-image” and “e-Presentment” technology to avoid paper, postage and mailroom costs.
SourceHOV Online Self-Service transforms how claims and re-submissions are managed with the speed and clarity that only a web-based, online, paperless process can deliver.
With our online document storage and retrieval solution, SourceHOV hosts the archival application document while you assign the document access parameters through our secure web connection.
Whether you are storing EOBs, claims or membership applications, our process eliminates the clients’ need or the capital expense of buying, maintaining or upgrading their own document imaging systems. SourceHOV becomes our clients’ virtual customer service department, eliminating your need to maintain multiple customer service locations, by providing you with one single, virtual platform that all customer service representatives can use.