iTech has introduced a "Seamless Claim Status Inquiry" feature in its expEDIum Medical Billing (eMB) product to make seamless inquiries from the original claims submitted through eMB. It is seamless in the sense that the inquiries can be driven from the aging claims, originally sent from eMB on few button clicks, perform the inquiries and all the responses are received in real-time, reconciled with the original claims and results presented in readable fashion. Note that the inquiries can be performed one at a time or in “bulk” for a given set of claims for a given payer or for a given set of ageing claims across multiple payers. Clinics can take further appropriate action after reviewing the claim status responses. We currently use Exchange EDI® as our preferred clearinghouse for performing claim status inquiries. We use Exchange EDI® as our preferred clearinghouse for Insurance Eligibility Verification too.
For a biller to handle aged / denied claims, they must first know the current status of the claims. Making calls to the Payers regarding the claim payment can be time-consuming and costly for the clinics. So, eMB’s Seamless claim Status Inquiry (CSI) makes the process easier & less expensive. Please note using this feature would incur transactional charges on inquiries performed.
Clinics can create inquiries from the "Claim search" results screen (from claim search, rejection search and denial search modules) and the response will be available readily on a Claim Status Inquiry List Screen which pops for the selected claims, and also from Search >> Status Inquiries menu which opens the Claim Status Inquiry List screen (the screenshot with same title is shown below). Clinics can view the history of inquiries performed across claims on this screen and view the inquiry/response of each claim.
The below screen shows the Claim search results screen from where Claim Status Inquiries can be initiated on a single claim or multiple selected claims or ALL claims from a given result set. Note that a single CSI gets a response within a few seconds, bulk inquiries would take several seconds to respond back.
Once the Claim Status responses are received, eMB reconciles the information with the original claims and applies status with color code on them based on the Claim Status Category Codes and Claim Status codes received in the response from the payers. These codes are used from the standard HIPAA code lists recommended for HIPAA X12N 277. These color code silos should help the billers analyze the claim status responses more efficiently.
Here is a dataflow diagram showing the data movement between eMB Software and the Payers.
Note that though electronic claim submission is covered by 96% of payers whereas Claim Status Inquiry is supported only by about 70% as per CAQH® 2019 report of payers. In other words, not all payers that support electronic claim submission support claim status inquiries. So, when you search on claims for submitting CSI from the expEDIum Claims search screen, if some claims do not appear in the result set this would mean the payers from such claims do not support claim status inquiries. expEDIum automatically filters out the claims from payers that do not support Claims Status Inquiry, from the result set. Note there is a per transaction fee on inquiries performed on expEDIum. Please contact us for pricing details.