ADVANCED RCM FUNCTIONALITY ALLOWS PRACTICES TO AUTOMATE THE SUBMISSION OF SECONDARY CLAIMS

One of the most significant leaks in a practice’s revenue stream can be traced to secondary claims. Many practices decide not to pursue secondary claims revenue because the cost of manually processing secondary claims, in terms of employee time as well as printing and mailing expenses, outweighs the financial benefit.

Advanced revenue cycle management (RCM) applications like those offered by Navicure leverage technology to automate the process and make it a profitable venture to process secondary claims. In fact, Navicure is able to send secondary claims to every payer:

• If its system is capable of receiving them, we can send secondary claims to the payer electronically. A list of payers that support electronic secondary claims submissions from Navicure appears below.
• If the payer is not capable of receiving secondary claims electronically, Navicure will print and mail the secondary claim, along with the relevant payment EOB information.
  Clients have two alternatives when forwarding their secondary claims to Navicure:

  • If your PMS can generate a claim file that includes the primary payment data and identifies the secondary payer, you can send the data to Navicure following the process you currently use to submit primary claims. Check with your PMS vendor to determine if they support this functionality.
    
  • If your PMS cannot generate a claim file with all of the necessary data, you can enter the primary payment and secondary payer information directly and Navicure will forward the information to the payer.

In short, Navicure’s automated process reduces the resources a practice invests in secondary claims submission to nearly zero – which means that each dollar captured can find its way directly to your bottom line.

Here’s the list of payers to whom the Navicure RCM can submit secondary claims:

• Medicare Nationwide
• Blue Medicare PPO – New Mexico
• Blue Medicare PPO – Texas
• Blue Shield – Illinois
• Blue Shield – Texas
• Champus - Tricare West
• DMERC Region B
• JI Specialty Services
• Medicaid – Pennsylvania
• Medicare – Railroad
• Texas Children’s Star Medicaid
• United Healthcare
• Valley Baptist Health Plan

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