Validate Medical Necessity
for Texas Medicaid
Murfreesboro, Tennessee, September 7, 2010…ClaimTrust, a leading provider of revenue cycle tools and services for hospitals, today announced that its InSight Compliance, a fully automated, web-based coding and compliance application, and InSight Medical Necessity, a tool that provides instant access to medical necessity requirements, have been updated to effectively scrub claims and validate medical necessity for Texas Medicaid. ClaimTrust’s solutions are the only available that offer deep customization and continuous updates for one of the most complex and challenging Medicaid systems in the U.S.
Utilizing its core Software as a Service (SaaS) architecture and experienced staff resources, ClaimTrust is offering Texas providers an easy and effective means to penetrate the complexities of Texas Medicaid rules by identifying claims that are likely to bounce back or deny before they are submitted. Providers are also now able to check for medical necessity prior to service while accurately scrubbing all Texas Medicaid claims. ClaimTrust’s staff continuously monitors banners, bulletins and provider manuals, interpreting and analyzing every update to make easy-to-read policies and accurate front-end edits.
Healthcare providers across the state of Texas have been able to incorporate InSight Compliance to detect a wide range of errors before the claims go out, including, complex chemotherapy billing requirements, improper provider numbers and CPT codes that are not covered by Texas Medicaid.
“ClaimTrust can solve most of the problems that lead to Texas Medicaid denials,” said Mary Guarino, Vice President of Regulatory for ClaimTrust. “Ask your hospital’s coding staff – the Texas Medicaid manual states that there are medical necessity limitations for chest X-rays. However, when you read the policy you will see medical necessity limits based on defined diagnosis codes, but the policy neglects to provide the CPT codes that pertain to this policy. ClaimTrust will code these difficult policies and ensure the policies include both the necessary CPT code and diagnosis code information. We review and combine information from provider manuals, bulletins, and weekly banners as well as create medical necessity and prior authorization policies that are easy to read and have all the latest coding and billing rules. And those examples are just medical necessity. We also create custom front-end edits that ensure your Texas Medicaid claims first pass pay rate goes up.”
InSight Compliance incorporates the most complete up-to-date library of payor edits in the industry, while also applying clinical logic to claims by identifying incorrect codes, deducing missing charges and generating net new revenue. Meanwhile, InSight Medical Necessity automatically reviews and compares diagnosis codes and procedure codes with the latest Texas Medicaid rules to prevent denials and ensure maximum reimbursement.
All major Texas payors are covered by the medical necessity tool and claim scrubber, including: Medicare, TX Medicaid, Anthem Blue Cross, Blue Cross of TX, Tricare, Aetna, Medicare PFFS Secure Horizons, Aetna Medicare PFFS and Humana Medicare PFFS.
InSight Compliance and InSight Medical Necessity are part of ClaimTrust’s InSight Revenue Cycle Solution®, the first hospital revenue cycle system to offer comprehensive all-payor edits designed to target the key inflection points in the revenue cycle to help hospitals find more cash than any other solution available today. ClaimTrust’s comprehensive revenue cycle solutions suite offers true all-payor support down to the MAC level and commercial payor plan level, while providing the industry’s deepest edit library. Other products in the InSight Revenue Cycle Solution Suite include, InSight Payment Variance Analyzer, InSight Reports, InSight Audit and InSight Denials.
About ClaimTrust
ClaimTrust focuses exclusively on hospital revenue cycle tools. That singleness of purpose enables it to deliver the industry’s most effective mix of software and services designed to ensure that hospitals collect more of the revenue they are entitled to as fast as possible. The ClaimTrust InSight Revenue Cycle Solution is a suite of Web-based products that target the key revenue cycle inflection points that have the greatest impact on the bottom line. ClaimTrust provides the industry’s most frequently updated and deepest edit library; the ability to find new revenue from unbilled charges; a denials analysis engine which identifies trends and rules to generate edits that no other vendors have; and true all-payor support.
