Claims Management

Claims Management

Clean billing drives faster reimbursements

Claims management technology improves medical billing accuracy and compliance with comprehensive clearinghouse and editing services

Healthcare providers reeling from improper billing and low first-pass rates can speed up reimbursements with a content-rich, integrated billing solution

Claims Management

Claims Management delivers a 98.7% payor claims acceptance rate and produces claims that result in full reimbursement, integrate with patient accounting systems and provide visibility across the revenue cycle
  • Checks every claim for errors and automates issue resolution with 28,000+ institutional and professional edits
  • Embeds edits within major patient accounting systems to prevent rework and create a single source of truth for compliance audits
  • Leverages extensive payor connections to speed up the billing cycle with comprehensive claims edit and clearinghouse capability
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Proven results

Achieves 98.7% payor claims acceptance rate
  • Resolves errors with 28,000+ institutional and professional edits
  • Achieves average claim rejection rate of less than 2% compared to rates up to 15% with other solutions or self-managed edits
  • Eliminates up to 90% of unnecessary follow-up

nThrive is accredited by the Electronic Healthcare Network Accreditation Commission for HNAP EHN (Healthcare Network Accreditation Program for Electronic Health Networks).

Claims Management Module

Claims Remittance Management

Automated process to retrieve, capture and store all electronic remittance advice files from payors to enable cash and note posting within EHR – eliminates follow-up calls, improves resource usage and cash flow consistency.

Bank Deposit and Remittance Reconciliation

Automated electronic remittance reconciliation process that identifies funds posted to the bank and how they reconcile to electronic remittance files.

Claims Management Reporting and Claims Analyzer

Claims Management Reporting allows users to access claim, explanation of benefits and denial information through ad-hoc queries. The queries can be defined as reports and distributed as specified by the user. Claims Analyzer is a web-based analytics platform that provides persona-specific KPIs at every level of the organization to drill down to the root cause of billing errors and ultimately improve claims outcomes.

Eligibility Management

Allows a secondary check for patient eligibility before submission to the payor. Edits can be built to stop claims that do not provide the correct eligibility or where eligibility for the payor doesn’t exist.

Medicare Direct Claims Management

Real-time claim submission for Medicare claims within Medicare’s Direct Data Entry (DDE) system to manage Medicare receivables online.

Electronic Attachments

Provides automated workflow for claims in additional documentation request (ADR) status enabling a streamlined process to submit and upload documentation into the Medicare DDE system or other payor connections.

Worker’s Compensation Solution

Allows providers to submit worker’s compensation transactions via Jopari’s worker’s compensation solution. Automated workflow allows attachments to be uploaded directly into Jopari and review reports for claims that require documentation.

Claims Status Advanced

Retrieval and capture of detailed claim status data prior to final claim adjudication enabling users to follow up only on outstanding claims, correct issues faster and accelerate revenue.

Paper Claims Printing Services

Prints, packages and mails claims, simplifying the paper claims process to decrease cost and follow-up efforts. Provides payor address verification to ensure providers are getting their claims to the payor correctly and efficiently.

High volume of rejected claims?

University of Washington Medical Center improves its clean claims rate with nThrive

University of Washington Medical Center:
Denial rate dropped more than 50%

California client:
Rejection rate improved 86% in 1 year

Major Northwestern healthcare provider:
Accelerated cash flow by $21.8M

Midwestern healthcare provider:
Monthly ROI increased 6.5x, equating to 37 FTEs

Improper billing delaying your reimbursement?

Claims Management maximizes first-pass payment rates

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Why nThrive

  • Our clients achieve an average claim rejection rate of less than 2%, compared to rates up to 15% among providers who use other solutions or manage their own edits
  • nThrive is the only vendor with embedded edits within the major patient accounting systems
  • nThrive ensures proper reimbursement and compliance across payors and understands the complexities of billing beyond clearinghouse functions
  • nThrive Claims Management solutions help eliminate up to 90% of unnecessary follow up

Low clean claim rate?

California-based healthcare system achieves 95% clean claim rate in one year

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2021 AFMA Annual Conference

HFMA Annual Conference

Visit us at booth #1542 to find out how to defend pricing and reduce denials with CDM Management, our new cloud-based solution for modern EHRs. Also, learn how to get the most out of your labor spend, plus improve operational and financial performance with Robotic Process Automation (RPA).

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