Claim Validation Tool

Claim denials can be a major setback for your practice as they have a negative impact on the cash flow and your practice’s efficiency. According to a research and subsequent survey conducted by the Medical Billing Advocates of America across the healthcare industry, 1 in 7 claims is denied mostly for reasons related to technical and human errors while filing for insurance claims.

Claim Validation Tool is a unique and unrivaled automated rule-based billing tool in the industry for avoiding unpaid claims. It can quickly scan each treatment plan and claim to check if they fail any terms and conditions which otherwise will require very high expertise and time. With built-in automated billing rules, it can flag potential coding issues before the claim is even submitted.

Although the latest updates in the coding language enables the providers with more precision when it comes to cataloging treatments; errors may still creep in due to the manual handling of the billing process.
Aligned with your office’s practice management software, this tool makes the billing process more efficient by notifying you of potential issues before the claim even leaves your system. Your staff can now process more claims, spend less time following up with insurances for stuck payments as you get paid on the very first attempt.
This robust automated tool simplifies the billing process for you and helps you avoid costly coding and administrative errors that lead to most claim denials.

Capline’s Claim Validation Tool pulls data from web-based insurance verification forms and the Practice Management Software and instantly detects claims which will not pass. It scans the patient’s demographic data, specific insurance plans and treatment plan codes to display what will not be paid based on more than 20 specific conditions like:

It also suggests the user for the specific codes and insurance plan requirements that will apply and must be manually reviewed.

1. Insurance Verification Validation: This interface compares the information obtained from the insurances and what is saved in your practice management software and alerts the user for any mismatches such as benefit max, deductible, percentage coverage, provider name, etc. Capline typically does this without needing any office intervention.
2. Treatment Plan Validation: It scans the codes in the treatment plan and matches it with Insurance Verification data and alerts the user which of the services will not be paid or be only partially paid. This can either be used by your office staff or Capline Services can provide dedicated resources for live checks on the fly in close coordination with the office staff.
3. Pre-Submission Claim Validation: It rechecks claims before submission to the insurance companies for any rules that are still not passing and will result in unpaid claims. Capline does this without needing any office’s intervention.

Capline’s Claim Validation Tool pulls data from web-based insurance verification forms and the Practice Management Software and instantly detects claims which will not pass. It scans the patient’s demographic data, specific insurance plans and treatment plan codes to display what will not be paid based on more than 20 specific conditions like:

Achieve excellence through a powerful and fully automated tool that provides flexibility, connectivity, and security along with analytics with critical information that is actionable and prevents your practice from heavy losses due to claim denials.

Contact us today to get started with this amazing tool and open up growth avenues for your practice!