Designed to create efficiencies and reduce the total cost of ownership, Xybion’s national medical bill review platform is the first of its kind.
Our platform is more than an adjudication system. We understand our clients have a broad range of claim philosophies, and while state legislatures and regulators make rules, interpretation of those rules may differ.
We incorporated an option-driven system allowing for almost infinite custom configuration possibilities. With national and state medical treatment guidelines and fee schedule rules built-in, and an embedded document management system, Xybion enables you to create “Your Process – Your Way”.
Includes fee schedule values and out-of-network negotiation. PPOs, MPNs, and other specialty network connections, standard and custom reporting, data analytics, and business intelligence.
The system checks whether a provider can invoice for the service billed. For example, a registered physical therapist may not bill for a physician’s office visit.
If the supply or service was already allowed under a previous billing, the platform checks and determines that the “unbundled” code should be denied.
Identifies and denies payment for services or supplies that duplicate previous charges.
Auto populates all the details of the patients and providers from the uploaded health insurance forms. Powerful OCR Engine can digitize and create claims forms.
Alerts both the provider and the adjuster to potential overtreatment and will request objective documentation from the provider.
Supports reconsiderations while keeping the integrity of the original bill/pricing intact while linking the reconsidered bill to the original.
The interface provides multiple options and formats for billing that can save time and effort for patients and the providers: EDI/FTP, scanned bills, fax, email/mail, manual.
Evaluates pre-existing relationships with multiple PPO providers to assist with additional savings.
Includes state reporting functionality for workers’ comp medical bills with electronic integration with reporting states. Built-in edits reduce rejections and support timely filings.
All possible diagnosis options are included that can be chosen and auto populated, minimizing data entry. Embedded rules allow customizable triggers. For instance, when diagnosis codes do not support the CPT codes or services rendered, manual entry can be performed.
For Example: (1) When bill type is a hospital bill (inpatient or outpatient, billed on a UB) AND an observation revenue code (760-769) is used AND billed charges are greater than $10,000 PEND the bill to a nurse task list. (2) When the bill type is a physician bill (HCFA) AND the rendering TIN is xxxxxxxxxx AND the procedure code is 99213 reduce the bill to $25.00 AND DO NOT send to PPO.
A robust, real-time dashboard that displays KPI’s and other key data sets. Dashboards and key data sets are role-based and integrate several bills by the client, daily savings, status of multiple bills, workload, and assignee’s information. auto-populated minimizing data entry. The system also has embedded rules that allow customizable triggers.