Encoda’s Claims Manager constantly monitors your practice management system looking for charges that have been entered and ready to be paid. Encoda retrieves these claims, imprints our proprietary “fingerprint” technology on each line item on every claim, then inputs these claims into Encoda’s claim scrubber. Our claims scrubber features the industry’s most robust technology utilizing a database of payer and specialty specific claim edits (LCD, NCD, MUE, and NCCI), historical edits including global periods, bundling and frequency counts, claim structure edits and client specific edits. The claims are scrubbed against this database (which is updated daily) and those claims that are ready to be paid are sent to the payer, while remaining transactions that require staff attention are routed and queued in Encoda’s Exception Manager for the appropriate staff member to work.
Exception Manager presents only those claims that need attention allowing your staff to focus on editing and correcting any claim issues before being re-billed. Once a correction is made to a claim in Exception Manager it is automatically corrected in the PM system.
Encoda BackOffice waits for responses from the payers, and once received, automatically records responses in the system and transfers the claim to the appropriate queue based on the response from the payer.
If a claim is rejected, it is automatically re-routed back to exception manager, along with an explanation from the payer explaining why the claim was rejected. If a claim is accepted, the claim is then moved into Encoda’s Payment Manager to start the posting process. Once the payment is sent to post, the poster records the payment and automatically records the payment in the PM system.
Encoda’s Watchdog continuously monitors the BackOffice system ensuring that responses are received for all claims submitted. In the event a response is not received from a payer or a claim has not yet been adjudicated, Watchdog automatically sends a notification to the payer requesting a status update/payment. These claims are all seen in the Watchdog queue.
Maestro Analytics is fully integrated with Encoda BackOffice and serves as Encoda’s business intelligence and dashboard reporting system, tracking all data that moves through Encoda BackOffice. Maestro allows Encoda clients to access practice management, clearinghouse and payer data in a single, web-based location.