A few days ago I had a call from a current customer. They needed help with a project to find claim data that met a certain criteria for additional action. In this case, a major commercial payer had paid claims late over an extended period of time to healthcare providers all over the country. This particular hospital had learned at a conference that they could collect the substantial interest on these claims by simply creating a list of the claims that qualified and submitting this list and supporting documentation to the payer. They had contacted a consultant that was going to assist them with this process. All they needed was a way to identify these claims and create this list.
One of our products (835Direct) is capable of loading electronic remittances (835s) into a database and mining the data back out in a variety of formats. It could have been used to examine the remittance data from this payer and produce a spreadsheet of all claims where the difference in the bill date and the payment date was greater than x. However, the software they use to obtain their remittances imported the remittances into a proprietary product for printing EOBs, posting to AR and such, but did not provide the capability of producing this list. Furthermore, this vendor does not forward the 835 remittances they receive on behalf of the customer on to the customer. After they are imported, they are archived by the vendor and the customer must pay service fees to obtain their own information in the original 835 format. This customer is exploring this option, but even if it is worth the expense, it will take additional time to obtain this information. Continue reading