Claims Management and Medical Billing Solutions

Few areas of the revenue cycle impact speed-to-payment as much as a strong claims processing system. Even small deficiencies in workflow can create redundancies, errors and rework that cost your health care systems millions in denied or delayed payments. Every claim must be closely scrutinized to ensure that your health system is compliant with new payment models, continually changing rules and regulations.

nThrive Claims Management delivers 98 percent claims acceptance rate by payors. Our software solutions produce claims that result in full reimbursement, are compliant with Medicare and payors, integrate with Patient Accounting Systems (PAS), and provide visibility across the revenue cycle. nThrive Claims Management prevents incorrect billing, accelerates incoming cash flow, reduces cost to collect, mitigates audit risk, and empowers process improvement throughout the revenue cycle to produce positive results in very little time. Read more to learn about our Claims Management solution components.

Seamless Claims Integration

Leverage the power of web service integration

To avoid duplication of work, your claims processing partner must provide for integration that increases the effectiveness of your patient accounting system (PAS). nThrive offers multiple levels of integration to fit your ideal business model; file sharing, upstream content delivery, embedding our edits into your EMR – nThrive has got you covered.

  • Push workflow upstream so the responsible department can address errors as they occur. Error categories are assigned action codes designed to expedite your billing operation’s seamless connections between Claims Management and your EMR system.

  • Maintain quality control, maximize productivity and compliance by leveraging our multiple models of integration with your patient accounting.

  • With implementation and adoption success teams assigned to your integration, we deliver integration best practices designed to leverage the most functionality from your claims and EMR systems.

  • Automate manual processes, and save time and money by taking advantage of integration points across your entire business office:

    • Claim submission to payor notification dates
    • Payor acceptance and rejection information
    • Status, eligibility, ERA and denial information
    • Medicare payment floor, RTP and suspense status
    • Multiple options to pass editing errors upfront
    • Streamline PAS system workflow

Claims Management Reporting

Increase performance with powerful reporting and dashboards

  • Identify and drill down to the most common reasons for payor rejections and denials. Our reporting capabilities help you address payor issues and pinpoint root causes of revenue leakage across your revenue cycle.

  • Achieve real performance management and understand the heartbeat of your billing office through comprehensive productivity dashboards.

  • nThrive customizable reporting capabilities give you the power to put your data to work. Quickly create your own reports to assist in cash forecasting, productivity management and more critical management functions.

  • Understand your payor trends. Successful health organizations can identify payors’ top reasons for denials, monitor their bill cycle times, and quickly react to increase performance.

Claims Status Solutions

Maximize follow up efficiency through automation

Claims statusing is complex and time consuming, challenged further by today’s environment that prevents staff from accessing accurate claim adjudication status. Streamline A/R management and follow-up processes to accelerate cash flow with easy access to detailed claim adjudication status.

  • Does your staff spend hours placing calls or logging into websites to obtain status data, yet still sees negatively impacted productivity, too-high A/R days and an escalated cost to collect? Let nThrive do the heavy lifting. Our teams eliminate manual status checks, and manage payors’ multiple phone numbers, websites and logins, relieving the burden from your collections staff.

  • Unlock efficiency and simplify payor status complexities using our combination of 277 status transactions and payor website web-scraping tool to improve data quality and maximize exception-based follow up for speedier claims payments.

  • Eliminate the manual processes of checking payor websites using our web-bot technology. The technology automates status details retrieval from the website. The information is sent to the nThrive Claims Management system and is packaged in posting files.

Case Study

Learn how Cinncinatti Children's Hospital gained back six A/R days and improved net cash collection by three percent with nThrive

Download the Case Study
nThrive eliminates wasted time and manual processes to boost productivity.
Claims Management Flowchart

Claims Clearinghouse and Payor Connections

Leverage our extensive payor connections to speed up your billing cycle

  • nThrive began converting paper claims to electronic submissions more than 25 years ago. Over the years, we have developed a strong, comprehensive payor connection list. We support more than 1,500 payor connections with payors representing all 50 states.

  • Our innovative and proprietary payor connection technologies deliver a simple and automated process from claim submission to status, and finally through ERA retrieval process. All the processes are integrated in our billing application to streamline claim rejections and automate secondary claim creation.

  • Enrollment forms are difficult to navigate, and often not completed correctly, creating a billing nightmare. nThrive payor support teams help our clients manage and complete EDI enrollments to ensure enrollments are set up correctly

  • For stubborn claims that can’t be submitted electronically, nThrive offers claims printing and mailing services with payor address verification. Let us take the strain of managing paper claim submission and free up time for more impactful tasks.

Remittance Management Solutions

Manage ERA and EFT cash posting quickly and easily

If your teams are still manually posting medical payments, you could be wasting staff time and resources, re-entering payments by hand. Our ERA and EFT electronic tools manage the entire remittance process and drive downstream processes to save you time and money. nThrive retrieves and captures ERA transactions directly from payors, eliminating the need to call the payor and follow up when files are not available.

  • nThrive applies intelligent business logic in the cash posting process to resolve issues created by inconsistencies across payor ERA files. It eliminates the need for manual correction often necessary after automated posting processes are complete. Remittance information is posted through batch or key emulation capabilities, including payments and contractual adjustments, as well as patient liability information, reason codes and other notes.

  • nThrive offers the ability to reconcile and hold payments until the deposit and ERA file are received. It’s a functionality that helps your team follow up on outstanding payments and remittance advice. Exception-based follow-up eliminates time-consuming manual reconciliation between ERA and check deposits for your cash posting team. An easy-to-read search functionality streamlines ERA review and facilitates faster, more accurate month-end closing through advanced reporting.

Medicare Direct Claims Management

Comprehensive solutions to maximize Medicare claim processing

  • Speed up your bill cycle time by harnessing real time Medicare processing. Our solution links into Medicare DDE system and is designed to optimize the way you manage Medicare claims. Medicare Direct’s front end eligibility checking matches your claims against Medicare’s common working file and HIQA, preventing unnecessary rework.

  • Take advantage of automated claim status checking directly from the fiscal intermediary shared system. Our status and workflow components work together to return eligibility and Medicare front-end errors the same day, so that you can begin correcting them immediately.

  • nThrive Medicare Direct Claims Management provides reporting capabilities that help you monitor consistent problems and forecast Medicare cash flow. By capturing data on Medicare’s payment floor, correction floor and ADR requests, information is sent to providers quickly to take action and eliminate costly delays.

  • Centralize and speed up Medicare documentation and records requests by using electronic Medicare documentation interface. Upload and attach documentation to your claims and submit directly into Medicare’s system. Let nThrive streamline timely and costly medical record documentation submissions by taking advantage of ESMD.

Best Practices: Cash Flow

Learn how Clarendon Health System cut out 13 Medicare A/R days, finding cash to reinvest in their community.

Download the Case Study