Maximize your claims adjudication process with this claims scrubber, pre-adjudication software
FirstPass™ is a rules-based claims scrubber software that applies generally-accepted and client-specific billing guidelines to medical claims. By applying these guidelines prior to entering the adjudication process, errors may be identified or eliminated before they populate downstream applications.
Customized editing rules can be created to allow the claims management system to be completely customized. The result is a faster, more precise claims adjudication process that delivers an increase in claims auto adjudication and first-pass rates.
FirstPass™ can be deployed as Software as a Service (SaaS) or accessed using API, FTP or other common applications. A software development kit option provides the flexibility to write code and build applications around FirstPass™.
How does FirstPass™ claims scrubber, pre-adjudication software work?
FirstPass™ allows health plans and payor organizations to check for all key clinical editing functions. These edits range from basic checks for accuracy of codes, appropriate use of modifiers, and validation of patient gender and age, to complex relationships such as instances of code fragmentation, utilization violations, mutually exclusive services, diagnosis/procedure relationships, and more.
Private labeling:
FirstPass™ can be customized to assume the existing look and feel of the front-end interface users experience when they access the system, including logo placement and other graphical elements which help users identify fields and navigate their way through the claims management process.
Identifies common infractions:
- Unbundling
- Re-bundling
- Service over-utilization
- Inappropriate and unnecessary services
- Modifier appropriateness
- Procedure/diagnosis attributes
- Procedure to diagnosis relationships
- Code validity
- Data integrity
Contact us today to request more information about this claims scrubber, pre-adjudication software for health plans and payor organizations.
