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 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 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 populate 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 over treatment 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

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 number of bills by 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.