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Santa Rosa, CA  95407
Phone: (800) 763-8484

Eligibility

Verifying patient eligibility is always the first step in successfully managing the claim lifecycle process. If you check eligibility by phone, you will only be able to verify patient coverage for as many patients as staff time allows. The number one reason for rejected claims is invalid or incomplete subscriber information.

ClaimRemedi solves this problem by delivering critical eligibility data to your desktop in a matter of seconds using a standard web browser — allowing you to obtain and verify the correct subscriber information before claims are submitted. Eligibility responses can also show what you need to collect from your patients to cover co-payments and deductibles.

Eligibility responses are presented in a consistent, easy-to-read format. All information is organized so that your staff can quickly find the information (for example, co-payment amount) they are looking for — without having to wade through pages of randomly arranged information. All information is displayed in a consistent format regardless of the payer. ClaimRemedi also eliminates the need to log on and off of multiple payer websites, each with their own unique logon and display of information formats.

You can obtain real time eligibility information from payer websites without logging on to individual payer websites through our enhanced payer access solution. We access the different payer websites — but provide you with a single logon for all payers — and we “normalize” all information so that it is presented in the same, consistent and easy-to-read format.

Guides and prompts are displayed to ensure that different payer requirements are met when submitting eligibility requests. For example, “Does the payer require the patient’s date of birth, etc.?” This includes error checking with automatic resubmission.

“Real-time” eligibility responses are returned within 3-7 seconds.

Eligibility requests can be submitted in a batch mode to facilitate the processing of information for many patients (for example, tomorrow’s schedule).

Your staff can individually set up and manage their own work lists with regards to their own preferences, inputting eligibility requests, saving responses on work lists and creating reports. Supervisors can be provided with access to all work lists and reports. Payer responses can be immediately displayed for review or automatically moved to a work list for later review.