Revenue Cycle Management

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Claims Management:

  • MDS Compliance
  • Claims Submission “NPHIES”
  • GSS Confirmation
  • Denial Management “Re-Submission and Rejection Analysis”

Claims Management Core Benefits:

  • Claims Management Team is providing professional claim processing that strongly based on: Claim Acceptance Rate.
  • Claims acceptance depends highly on the accuracy and completeness of the submitted information according to updated MDS requirements and NPHIES rules.
  • Experienced claims team can monitor claims validation and scrubbing that will boost the claim acceptance rate.
  • Claims Appeal and Re-submission Handling : Sidra Claims team must re-work and re-submit all denied or rejected claims within agreed regulatory grace period.
  • A Month-Over-Month Revenue
  • Billing and Coding Accuracy: to ensure that documentation matches with the codes and that errors are kept to a minimum.
  • Accuracy and completeness help reduce denials and allow the practice to breeze through audits.
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Claims Management Workflow:

  • Manage Auditing All Claims to identify inconsistencies.
  • Track all (Claims / Data Entry & Billing Officers) process to grantee working Accuracy / Efficiency. (Technical wise).
  • Review Billing terms and update the Required terms to match the service provider needs.
  • Collects and analyzes working outcome/output data daily to process recommendations and needed fixes based on audit results.
  • Proper Documentation To ensure full submission rate.
  • Train / Develop The team to meet Organization Strategies Plans (Periodic training program).
  • Follow up Deadline and report the Deviations to the client With recommended CAPs.
  • Report Any irregularity noticed during the audit and/or closing of claims.
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TOB Adminstration

01
Contracts Summary
02
Review & Adjustment of HIS Tariffs
03
Review Active Policies In System
04
Create Main Account Policies For Every Insurance Company
05
Create New Appointed Policies Based on Both Policy Expiry Report & Main Account Result
06
Create TOB Summary
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Contracts Summary

Contractual discount schemes "consultation discount, other services discount, pharmacy goods discount, package deal discount, etc..."

Prompt payment discount if any.

Volume discount if any.

Preparation for accurate contractual tariffs setup

Review & Adjustment Of HIS Tariffs

Audit all HIS available tariffs.

Adjust tariffs that need adjustment.

Create needed new tariffs.

Ensure accurate billing when it comes to approval limit, discount schemes & patient share.

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Review Active Policies In System

Check all active policies on HIS.

Re-check linked tariffs with active policies.

Adjust needed policies if any error encountered .

Create policy expiry report.

Maintain well updated polices.

Create Main Account Policies For Every Insurance Company

Incase Nphies direct integration is not available.

Create main account policies for every insurance company with all possible tariffs.

Daily check up of linked patient on main account to be redirected to their proper policies.

If policy is not available, we can accept patient based on eligibility result without delay of service delivery.

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Create New Appointed Policies Based On Both Policy Expiry Report & Main Account Report

Incase Nphies direct integration is not available.

Based on main account linked files and policy expiry report, create new policies on the system and link it with its correct tariffs.

daily update of policies to ensure accurate billing.

Create TOB Summary

Create summary of important coverage conditions out of CCHI standard TOB to be distributed to all concerned stakeholders.

Increase revenue by drawing attention to special coverage.

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