Claims Scrubbing with InSight Compliance®
A Claim Scrubber for All-Payor Clean Claims
InSight Compliance is a fully automated, web-based, coding and compliance claim scrubber that automatically identifies claim errors prior to submission for any and all payors. Our clients use the most complete and up-to-date library of payor edits in the industry, including rules for Medicare fiscal intermediaries and plan level edits for commercial payors,. Far more powerful than most simple claims scrubbers, InSight Compliance also applies clinical logic to your claims to identify incorrect codes and can even deduce missing charges, generating net new revenue for your organization.
Custom Edit Library for Your Facility’s Payors
Craneware InSight works with you to develop an edit library that is specific to the payors in your institution. We go beyond basic OCE and LCD claim scrubbing. We work with your facility to provide medical necessity logic that takes into account prior authorization and age and gender, as well as CCI, APC, MCE, and Codefinder edits. Your custom edit library is updated with the latest rules weekly at no extra charge, making it by far the most comprehensive and effective claim scrubbing software available. With a highly flexible filtering system that allows hospitals to scale up claim filtering intensity as appropriate for their organization, our clients are able to quickly reach maximum claims compliance with minimal impact on daily throughput. Our team of revenue cycle experts is constantly researching, investigating and discovering these unpublished edits and updating them into our web-based system on a weekly basis to ensure that our clients fully benefit from the most up-to-date and comprehensive payor edit library in the world.
Net New Revenue from Unbilled Charges
InSight Compliance’s advanced clinical logic and analytics are designed to deduce missing claim components that should be present in specific claims. This powerful capability not only ensures that your organization receives all of the compensation due for the services provided, it generate net new revenue from within the coding process itself.
Since many claims involve multiple teams, the intelligent workflow engine also supports communication and corrections across departments and facilities and continues tracking denied claims until they are resubmitted to the payor.
InSight Workflow and Claim Editor
Insight Workflow and Claim Editor work takes the claim edits and errors identified by InSight Compliance and gives your staff an easy-to-manage worklist and a real-time claim editor to ensure clean claims are submitted as efficiently as possible. The worklist provides intelligent routing and simple repair of any claims flagged during the pre-submission, claim scrubbing process. Claims are routed to the appropriate user and presented in a simple, familiar user interface so they can be repaired and submitted in the correct format as quickly and efficiently as possible.
With an intuitive and comprehensive editing toolset, rich all-payor knowledgebase and intelligent routing to ensure maximum efficiency, InSight Workflow & Claim Editor will transform your revenue cycle process.
Real-time Claim Scrubber and Editor
InSight Workflow & Claim Editor operates as a virtual UB-04 editor with the ability to review, repair and revalidate claims in real-time. After editing, you can scrub the claims as many times as necessary through the InSight Compliance claim scrubber to ensure a clean claim and output in 837 file format.
Intelligent Workflow Routing
Our intelligent workflow engine automatically determines which individual or department should receive each claim. The system also allows for multiple escalation levels configured according to internal hospital policies and includes a supervisor role for oversight and management.
Denials Feedback Loop for Continuous Improvement
Craneware InSight works with you to create the edits that are most needed in your facility. We do this by reviewing your payors’ rules and your contracts with those payors, as well as our detailed database of denials received by payors in all 50 states. The Craneware InSight database of denial information provides a level of detail that cannot be touched in the industry. When used in conjunction with InSight Denials, InSight Compliance creates a complete denials feedback loop, a powerful continuous-learning mechanism that can dramatically increase billing process effectiveness and significantly impact cash flow and net new revenue.
