Medical Bill Review

A New Choice for Medical Bill Review Software

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”.

Emidence XD Bill Review Benefits:

  • Supports workers’ comp, auto, and group health.
  • Seamlessly integrates with claims systems: proprietary or third party.
  • 100% cloud-based and accessible via any device
  • No software to download.
  • Network management and contract pricing available within the system
  • Immediately access and connect internal systems that drive medical bill review.
  • Available as a lease option or as a service option
  • Mailroom service available
  • Multiple bill intake options
  • Real-time integration with ODG
  • Embedded document management system – no third party needed.
  • Fully compliant with latest data standards and regulatory guidelines
  • Configurable – updates take days, not months.
  • Established interfaces with clearinghouses and preferred provider organizations.

Screenshots:

Core Bill Review Feature:

Fee Schedule:

thumb-mbr-fee-schedule-1

Key from Image (KFI):

Diagnosis and CPT entry:

Key from Image (KFI):

Software Features

Medical Bill Review Basics

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.

Appropriateness of Care

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.

Unbundling

If the supply or service was already allowed under a previous billing, the platform checks and determines that the “unbundled” code should be denied.

Duplicate Billing

Identifies and denies payment for services or supplies that duplicate previous charges.

Key from Image

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.

Utilization Review

Alerts both the provider and the adjuster to potential overtreatment and will request objective documentation from the provider.

Recon/Appeals

Supports reconsiderations while keeping the integrity of the original bill/pricing intact while linking the reconsidered bill to the original.

Bill Intake Methods

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.

EDI Support

Evaluates pre-existing relationships with multiple PPO providers to assist with additional savings.

State Reporting for Workers’ Comp Medical Bills

Includes state reporting functionality for workers’ comp medical bills with electronic integration with reporting states. Built-in edits reduce rejections and support timely filings.

Diagnosis and CPT Entry

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.

Client-Specific Business Rules

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.

Bill Review
Dashboard

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.

Ready to learn more? Contact us to Setup a Demo.

Heidi Krueger

Head of Quality Assurance

Heidi leads Xybion’s Quality Assurance practice. She has over 20 years’ experience in designing and implementing quality assurance policies. Since joining Xybion in 2000, Heidi worked with several clients to design quality policies and ensure compliance. She is responsible to hosting Xybion customer audits. Heidi has a BA degree in Biology from The King’s College.

James Castonguay

Product Technology Lead

James provides leadership to Xybion quality management systems including product design, development and client delivery. James started working with Xybion in 2002 in its Canadian division. He is now managing product delivery from the United States. James has a master’s degree in mathematics and minor in informatics from the University of Sherbrook, Quebec, Canada.

Dave Chiaramonte

Enterprise Assets and HSE Leader
Dave brings diverse and deep expertise to his leadership role as the leader of Enterprise Asset Management (EAM) and Employee Health & Safety line of business. Dave has over twenty years of experience within the Information Technology industry including development, implementation and integration of complex Enterprise Systems in large corporate environments. He is a highly regarded technology leader in IBM’s Maximo Asset Management Product implementation. Dave worked with BMS and Dupont pharmaceuticals before joining Xybion in 2004.

Tom Klapmuts

Digital Lab Solution Leader

Tom provides leadership in design, delivery and revenue growth of Xybion digital lab solutions. He is an experienced client solutions manager with a demonstrated history of working with many clients globally to solve their business problems. Tom has training in U.S. Food and Drug Administration (FDA), Good Laboratory Practice (GLP), Life Sciences, CRO Management, and Clinical Development. Before joining Xybion, Tom worked for pharmaceutical companies such as Merck and Schering Plough. Tom is a Purdue university alumnus.

Priya Rajesh

Head of Sales: APAC & EMEA

Priya is responsible for Xybion business growth in APAC and EMEA region. She brings over 18 years of experience in Business Consulting and Operations Management. Her deep expertise in diversified areas, including strategic alliance and partnership management, diversity and inclusivity initiatives and employee development, will amplify Xybion’s global strategic relationships and will strengthen the company’s executive leadership in India. In her last role at Conduent, she served as Director-Marketing & Bid Management. Prior to this, Priya has worked with Infosys and Covansys (now CSC). Priya holds degrees in microbiology & health management.

Raji Bijur

Head of Quality Control & CSV

Raji leads Xybion Quality Control function. She has over 22 years of experience in software quality management, CSV, SQA, software process & KPI development and industry benchmarking. She has strong process implementation knowledge including ISO, CMMI, Agile, Scrum, Six Sigma, Lean. Certified CSQA, CSV, GCP, and GAMP. Raji has led implementation of QC processes in Robotic Process Automation (RPA) projects. Before coming to Xybion in 2019, she worked with IQVIA (Former Quintiles), Infosys, Aris Global, Mphasis and serving clients across different market segments. Raji has a bachelor’s degree in information science & technology and MBA from Indian Institute of Management, Ahmedabad.

Bob Friedman

Chief Solution Architect

Bob Friedman has over 25 years of experience in Preclinical information systems at Xybion Corporation as a developer, development manager and Chief Solution Architect. He has been an active member of the CDISC SEND standards consortium for five years as well as the PhUSE / FDA Industry Collaboration. Bob has previously worked for Synthes Orthopedics, NYU Medical Center and the New York State Department of Health. He has a master’s degree in Biomedical Engineering from Rensselaer Polytechnic Institute.

Gokul Panda

Head of Platform and Product Development

Gokul is the Head of Platform and Product Development, responsible for developing new and critical platforms and products. He has over 20 years of enterprise software development in the life sciences industry and related fields. Gokul holds both a Bachelor’s Degree and Master’s Degree in Engineering from the Indian Institute of Engineering, Science, and Technology. Gokul’s unrivaled expertise in enterprise software architecture and solutions provides Xybion’s clients with leading product functionality, innovation, and platform stability.

Anu Roy

Chief Solutions Delivery Officer

Anu manages project delivery and relationship. She has over 18 years of Life Sciences industry and IT services experience. Anu has a strong track record of designing and developing digital solutions, management consulting, quality & compliance Management, CLM, process & key metrics design, program execution & improvement and account management. Anu is a recipient of the STEM WOC ‘Technology Rising Star ‘by US Women’s magazine in 2014. She has received several other awards including Infosys Consulting Architect Award for outstanding achievement in 2011, RCL Crown Golden Brain Award in 2013. Anu is a guest columnist at Pharmaceutical Compliance Monitor and published in several international business magazines. Anu has a bachelor’s degree in Biochemistry and MBA in marketing.

Keith Dempsey

Chief Information Officer

Keith Dempsey has joined Xybion as our global CIO. He brings 20+ years of progressive Information Technology experience from Merck, AIG, Barclays and PriceWaterhouse. Focusing his career on building global strategies that capitalize on progressive technologies that scale in accordance to realized business growth. His experiences range from introducing new technologies that facilitated a competitive advantage for Merck, introduced new and scalable technologies for AIG Investments, and created progressive global organizational improvements for Barclay’s Capital. Keith has a degree in Chemical Engineering from Clarkson University and an MBA from William Paterson University.

Steve Porfano

Executive Vice President & Chief Financial Officer

Steve manages Xybion corporate function which includes Finance, HR, Legal and QA. Steve joined Xybion in 1989 as Corporate Controller and was promoted to Chief Financial Officer in 1991. As Chief Financial Officer, Steve is responsible for the establishment, enhancement, coordination and administration of the Company’s financial systems, internal controls, and related areas. Additionally, he is the corporate liaison to the Company’s bank, independent certified public accounting firm and governmental compliance and financial auditors.

Kamal Biswas

President & Chief Operating Officer

Kamal joined Xybion as its President and Chief Operating Officer in 2018. He is an acknowledged leader in the life sciences industry and has over 20 years’ experience in management consulting and pharmaceutical business. Very recently, Kamal was a Partner and leader of the global Life Sciences practice at Infosys Consulting. Before that, he spent several years working with pharma companies including Novartis Pharma and Ciba Geigy to manage manufacturing and late-stage R&D functions.

Pradip K. Banerjee, Ph.D., MBA

Chairman of the Board & Chief Executive Officer

Dr. Banerjee is an entrepreneurial senior executive with 30+ years of in-depth experience in the global Life Sciences, Healthcare and Services industry in global operations, strategic management, business development, investments and new ventures creation, M&A and Buy-outs. Prior to acquiring Xybion in 2008, Pradip served as President and CEO of Science Center in Philadelphia focused on creating, incubating, managing and investing in science based new companies. He was the Partner-in-Charge of the pharmaceutical Research & Development unit of Accenture where he created the R&D consulting unit and had grown it to become $100+ million worldwide business. Dr. Banerjee holds a Ph.D. in Pharmaceutical Sciences from University of Wisconsin-Madison and an MBA from the Wharton Business School of University of Pennsylvania.

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