alloFactor: Medical Practice Scheduler, Billing, EMR Software & Patient portal

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Insurance Billing

Claims module is geared towards billing staff to most productively manage insurance claims. Once a visit is completed, the claim automatically flows into the claims module. If the patient diagnosis and charge codes were entered during sign-out, creating the claim with a single click. Claims can be instantly filed or batched for electronic or paper filing. Payment can be instantly posted through ERA and paper EOBs can be manually posted. Super-bills and EOBs can be scanned and stored electronically. All communication relating to a claim is structured for easy retrieval. Claims can be printed using customized provider or payer or printer specific templates.
Never miss billing Encounters As soon as the front-desk checks in a patient, the visit immediately appears in the Claims module as a visit to be billed. Tracking visits in this fashion ensures that not a single claim goes unbilled.
Rapid Claim creation Once you have received the diagnosis and charges from the frontdesk, creating the claim is a snap. Typically if you have setup defaults, you can create the claim at the click of a button. If you are new to billing of if you need to override the defaults to gain specific control over individual fields, you can use the claim creation wizard.
Tracking Claims Typically medical billers work on a group of claims with a certain status such claim denied or primary paid. In alloFactor, each visit can be tracked through its life with the various statuses, thus tuned to the way your staff works. The status is automatically managed by alloFactor. Your billing staff can also manually change the status of a claim or a group of claims at any time.
Communication with Front-desk Whether your billing staff is internal at the clinic or an external vendor, there are likely to be clarifications to the front-desk staff. alloFactor provides a clarification module to systematically raise questions and answer them in a structured format and associate such questions with individual claims.
Easy charge capture Diagnosis and charges can be easily captured and transmitted to the biller in various forms. They can be entered directly into the system by the front-desk by the physician through EMR module. Or it can be marked on the encounter form by the physician and scanned into alloFactor. Or it can be entered in mobile device and synched using alloFactor desktop. Use explosion codes to quickly enter a commonly used set of charges along with their fees, modifiers, POS and TOS.
Scanning superbills & EOBs With alloFactor, you can easily scan in superbills and EOBs and use the system as a document management system. Quickly review which documents need to be processed. After working on a superbill or EOB billing staff can mark them as processed.
Setup billing defaults You can easily setup billing defaults such as default group, NPI numbers, tax ids, facilities to reduce the time you spend on each claim. In fact if you set them up, creating a claim is as simple as enter the diagnosis and charge for a claim.
Submit claims electronically After creating a claim in alloFactor submit it instantly to over 2000 payers at the click of a button. No longer do you need to create print images and go to separate websites to submit them. Now do you have to deal with different clearinghouses to submit your claims - we take care of all enrollments for you. You will get instant response on whether the claim passed the built-in edits in alloFactor. Once submitted you will continue to see detailed status of the transmission to the payer. See more details on electronic claim submission here
Print Paper Claims Alternatively when you do need to send in paper claims, you can print CMS1500 claims and mail them out. Default formats are included in the system; but you can modify them to adjust for printer specific spacing or create separate formats with default texts for different payers. You can create primary and secondary claims formats specifically for corrected claims.
Claim Status Once a claim is submitted electronically, alloFactor posts detailed status as it makes its way to the payer. First alloFactor checks the claim against its own internal claim edit database and immediately rejects any claim that fails the edits. Once rejected the status of the claim will immediately change to 'Claim Rejected' along with the reason for the rejection is given so that you can easily rectify the issue and resubmit the claim immediately. Next as it makes its way through the clearinghouse, the claim goes through additional edits and any rejections are posted to the claim. Finally the claim is passed to the payer and any rejection from the payer is made available to you.
Posting Payments alloFactor has a streamlined payment posting wizard to help your billing staff post payments without any errors. It starts by entering the total check amount and then decrements the unapplied check balances with each claim payment posting until it is down to zero. Entering a claim payment is a snap as alloFactor automatically calculates adjustments. Automatic checks prevent data entry error at a claim level as that it is very time consuming to cross check a claim level error at the end. A final consolidated review screen gives the detailed breakup to quickly nail down any claim level errors. Once a payment is posted manually or electronically the status changes automatically to indicate the completed task.
Error codes Enter claim error codes instead of keying detailed notes to speed up the payment entry process. Setup rules for each error code and setup follow-up actions. These error codes will help you decipher the cause for denials or underpayments if you need to refer back to it at a later point in time.
Electronic Remittance Advice (ERA) One of the most productive yet least used EDI transactions is electronic remittance advice. With ERA, you receive the same information as in paper EOB in electronic format. One of the advantages is that you get an ERA instantly while paper EOB can take days to reach you. But more importantly, ERA eliminates the hours that your biller puts into posting payments against each claim. With alloFactor ERA, the payments are automatically posted and any that cannot be posted automatically is marked for manual posting. You can also view your ERA documents in Adobe Acrobat(tm) format and save them or print them directly from alloFactor. See more details here.
Working claim rejections and denials If a claim is rejected by alloFactor, clearinghouse or payer, its status is automatically changed to Claim Rejected. If you are using ERA, any claim denied by your payer is automatically changed to Claim Denied status. Your billing staff can pick up only rejected or denied claims and work on them, using the detailed information on the cause of the rejection/denial.
Checking claims for errors If you are solely relying on manual error checking it will cost you time and money! Our built in business rules engine scrubs your claim against our internal rules database to prevent claim rejections and denials. Check each claim for error at the time of creation or during electronic submission.
Set up Custom Rules Along with default rules within alloFactor you can setup your own custom rules. Claims are checked against these rules as well before printing or electronically submitting your claims. One of the powerful features of custom rule section is to override individual fields to a specific text or specific value based on the provider or payer or state. You can also set up specific relationships between charges and diagnosis, combination of charges and provider and facilities.