Claimsure

Managing the health insurance revenue cycle is more critical in today’s healthcare environment than ever before. Hospitals all around Ireland have turned to Claimsure to address these ongoing demands and have found the implementation of our software to be a catalyst for millions of Euros in savings, by reducing costs, cutting debtor days and increasing cash receipts as well as identifying more opportunities for revenue growth.

Claimsure is an electronic claims management solution for healthcare organisations. Claimsure allows the capture of patient signatures and consultant data electronically and facilitates electronic submissions to the insurers. It provides a comprehensive reporting facility to allow full oversight of private health insurance debt.

Claimsure-What’s in it for me?

CEO: 

• A fast project that delivers wins for Finance, Clinical and Claims Administration staff backed by a clear business case; and
• It reduces the amount of time needed to be spent, across the entire Hospital, on the management and processing of Private Health Insurance claims, enabling you to realize substantial reductions in (a) time from discharge to submission of claim, (b) time from submission of claim to payment, (c) rate of pended claims, (d) rate of rejected claims and (e) resource administration costs.

Finance:

• Claimsure can be delivered quickly, working the way that you do currently, whilst incorporating best practice from the processing of claims followed elsewhere. It is also configurable to allow you to incorporate your own specific process requirements;
• It releases sustainable financial benefits through a significant reduction in debtor days and aged debt which generates additional cash for working capital purposes;
• It places the service provider in an ideal position to drive revenue maximization and cash collection as part of both a devolved and shared service finance model;
• Payroll spend is now more focused directly on patient care rather than administration. True cost of care enables better decision making: How many staff do we require per ward/bed/patient?
• It improves the quality of communication with the insurance companies, no longer discussing lost or delayed claims as they are electronically submitted and tracked on a daily basis; and
• Easily obtainable reports which include KPIs, outstanding consultant claim report, submitted claims by insurer report, bed utilisation report, finance summary report and many more.

Consultant:

• My Claims can be accessed anywhere…I can access in the office, at home and see my work list remotely, securely, review and sign off electronically;
• It’s quicker to use…I have the option to batch, preview and sign off all claims in one easy step or preview and sign off separately;
• I can also create a favourites procedure listing and favourite field text, copy general diagnosis information from previous patient, so my consultant notes are quicker to fill out;
• I can choose to invoice directly from Claimsure or it can connect directly to my own Practice Management System, to link the invoice via email, to the claim with no paper; and
• My cash flow increases as my income is not tied up in third party claims.

Patient Accounts/Admin:

• Claimsure enables the faster collation of claim from point of creation to point of submission;
• Claimsure tracks electronic claim submission, bed utilization, current bed occupancy, room designations and re-designations. Claimsure also allows me to track new admissions.
• We can now Report automatically by exception, Consultants upholding claim completions, KPI’s, Metrics on Insurer Response Times and compare trends through life-time access to claims log.
• Claimsure enables us to manage by exception, enabling fast follow-up of unpaid submitted claims (pended, rejected, part-paid or no response).
• For the best use of staff time, they can now be allocated to more productive use, adding value across the hospital. Claimsure can be implemented in phases, enabling a migration of work in progress whilst new claims are processed electronically.

Admissions:

• Patients can be admitted to the hospital quicker using the electronic claims process.
• Patient demographics are now carried across through integration which saves time by eliminating duplicate data entry.
• With the pre-populated forms, we can capture the patient signature easily on Insurance and Hospital Consent Forms and electronically store them alongside the claim.

IT Department:

• Claimsure will support new developments including pre-validation of Insurance cover and pre-authorization of Treatment; plus Claimsure is secure and fully backed up, nothing is ever lost.
• Claimsure is implemented quickly by Sláinte Healthcare which lets us carry on with our daily tasks uninterrupted.
• Claimsure is delivered in line with a contractual Service Level Agreement.

• Demographics and signature capture at admission point;
• Insurance cover validation in real-time;
• Aggregation of clinical summary for provider/physician billing;
• Consultant/Physician signature support for claim approval;
• Reconciliation of physician code charges to provider codes;
• Invoice generation from source data as desired;
• Pre-submission validation of claim to reduce denials, returns;
• Code libraries tailored to end-users;
• Progressive elimination of paper from the entire revenue cycle process;
• Automated reconciliation of payments/denials/returns; and
• Leverages existing technology infrastructure with tight integration.

Downloads

To view Claimsure brochure click on link below. To download brochure right click, and choose ‘save file as’.
Claimsure Revenue Cycle Management (1,154mb PDF)