Encoda BackOffice is a cloud-based (SaaS) medical billing platform that bridges workflow gaps between practice management systems, clearinghouses and payers.
One place to work all claims.
Continuously monitors your billing software looking for batched claims that are ready for submission to payers.
Validates claims and prevents potential rejections and denials prior to submission so you get paid faster.
Presents scrubbed claims prior to submission and claims that have been rejected/denied all on one screen.
Constantly monitors each of your payers for available remittance files and retrieves payment information without staff involvement.
Automatically monitors each of your payers to make sure no claim reimbursement is left behind.
Provides web-based, key performance and financial metrics by staff member, medical provider, and payer, in real-time, 24 x7.
How it Works
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.
“We’ve been using Encoda BackOffice for 90 days. BackOffice had an immediate impact on our billing dept. We had 3 A/R employees and we’re now down to 2. We had 2 payment posters and we’re down to 1.
There were lots of BackOffice rules that we implemented and it has helped our claims go out cleaner and has streamlined our posting. The Encoda support team has been awesome. They call us to let us know we’ve got an issue with a claim before my team even sees it. I’m sure there is more we need to learn but what we have experienced so far has been nothing but greatness!”
We were really at the end of our rope. Whether it was billing or running reports, everything of any value we did in our existing billing software and clearinghouse involved an agonizing process. But thanks to Encoda BackOffice, our productivity has skyrocketed! Today we bill for more than 130 providers with a staff of just 10 employees.
The Encoda BackOffice system connects to our existing practice management billing software. Additionally, Encoda has absolutely the best support we have ever had. When we need them they are always there for us. I know this sounds like an ad, but it’s the truth. Thank you, thank you, Encoda.”
“We purchased our practice management system because Encoda BackOffice is fully integrated with it. We bill for 20+ providers, and have re-engineered our central billing office around the Encoda platform. BackOffice has completely revolutionized how we go about claim submission, payment posting, and claim follow-up.
Patient copay reallocations and payer recoupments are all handled automatically by the Encoda BackOffice platform.”
“Encoda provided true scalability to our billing operations. We were seeking a ‘rules engine’ to automate the many manual performed repetitive keystrokes typical in most billing settings. As a result of Encoda BackOffice, our system is now ‘smart’; automating the mundane and freeing up our staff to spend time only on issues which truly require judgment.
We support 30 providers with only 3 FTE employees handling billing, posting and follow-up. Encoda BackOffice has been able to do everything they claimed it would do – and that’s not something I can say for most other software I’ve ever implemented!”
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