|
What We Do: Claims Management is primarily responsible for the
submission of claims to payers for the Vanderbilt Medical Group physicians and allied
health professionals. Not all payers accept electronic claims however currently
the VMG Business Office submits 89% of primary claims electronically in a HIPAA
compliant 837 P format. The average monthly claim volume for the VMG Business Office
is >133,000 claims.
Claims are filed directly to the payer for Medicare, Blue Cross Blue Shield, Kentucky
Medicaid and Kentucky Medicare. Three clearinghouses are used to transmit other
electronic claims, Emdeon, MedAvant and Track-N-Post.
Prior to billing, system edits have been matched to the payer identifying claims
that would not meet billing requirements. Claims Management staff work with Central
Registration and Physician Billing Services to correct these errors prior to submission
preventing a portion of claim denials by sending clean claims.
Service -Transmit or bill paper CMS1500 (08/05) claims for VMG,
VASAP and UCHS. Provide account maintenance through Account Correction requests
from patients, intra and/or inter departmental requests.
Quality - Correct identified claim errors. Insure that all account
correction requests meet documentation and compliance guidelines prior to processing.
People - Make those we serve: patients, physicians, billing and
registration staff our highest priority by honoring patient privacy and following
best business office practices.
Financial - Decrease the number of days in Accounts Receivable
by increased electronic claims filing. Most electronic payers make payment within
14-21 days of receipt of a clean claim. Direct transmission of claims to payers
eliminates the billing expense of clearinghouses.
Growth - Electronically file secondary claims to BCBS of TN and
Cigna.
|
Adobe Acrobat Reader
Excel 97 Viewer
PowerPoint Viewer
Word
97 Viewer