Leveraging machine learning to identify quality issues in the Medicaid claim adjudication process. Delmolino, D., & Whitehouse, M. (2018). Responsible AI: A framework for building Trust in Your AI solutions. Diakopoulos, N. (2016). Accountability in algorithmic decision making. Communications of...
EMCsoft’s Claims Management Ecosystem assures that healthcare providers deliver clean claims to insurance payers for proper claim adjudication.
As a result, payers are able to minimize overpayments and reduce avoidable manual touches during the adjudication process. THE OUTCOMES WE DELIVER Automatic Bang for your Buck ApexonClaims delivers significant efficiencies: 20% reduction in the number of touches 100% review of claims 10% ...
applies advanced clinical and coding algorithms to nationally sourced edits, flagging suspect claims. The suspicious claims are then reviewed by teams of analysts, coding experts, and consultants before final adjudication. And results are fast—in most cases, we render payment recommendations within ...
others,suchasRuralHealth Clinics(RHCs),chronicdialysis servicesandAdultDayHealth Care(ADHC) ANSIandMedi-CalFormsTheCMS-1500andUB-04claimformswereadoptedbyMedi-Calin 2007tocomplywithFederalandStateregulationspromoting uniformityinbilling.Theseclaimformsusethewidelyaccepted ...
Easily manage audits from the Letter of Intent (LOI) to Audit through adjudication. Track Audit Stages Track all aspects of audit stages from pending to closed and every stage in between. Cloud Based Sync Synchronizes seamlessly with Outlook HIPAA-HITECH Compliant Cloud Based Rich reporting...
The Management Side of Due Process: Some Theoretical and Litigation Notes on the Assurance of Accuracy, Fairness and Timeliness in the Adjudication of Social Welfare Claims Virtually no American is likely to live out his life without making a claim under some federally funded or administered benefit...
EMCsoft’s Claims Management Ecosystem assures that healthcare providers deliver clean claims to insurance payers for proper claim adjudication.