The new DSM insurance system takes advantage of the services of DSM’s third party scrubbing partner, Yost Engineering Inc. (YEI).
To scrub a claim the insurance clerk clicks “Next Step” which presents options in a dialogue box. The clerk then selects “Scrub Claim” which sends the claim info to YOST through secure Internet communications.
The clerk receives a report back that looks like the following (click on the image to enlarge):
The report above is also parsed out to the “scrub” window of the claim, which is on the same screen as the claim. It’s all on one screen for the insurance clerk. To mark an error as having been corrected, the clerk double clicks the error.
Errors are fully described (left). In this case, the error is medical necessity and the Policy Number from the CMS book is displayed along with the policy name. A policy hyperlink is provided which allows the clerk to click the link, opening a browser window with the appropriate bulletin in the “Medicare Coverage Database Archive”. How easy is that?
The edits are all up-to-date because the claims are scrubbed online with the latest updates. No downloading of voluminous files to edit against, just keep an Internet connection.
Both Yost and Ingenix are contracted through DSM, so no having to deal with a third party, just DSM.
Thanks for reading, keep checking, more articles coming!
DSM announced at it’s recent summer EMR conference a completely new set of programs for processing insurance claims. The new system has been designed to the latest 5010 format required by CMS. The 5010 format requirement will take effect sometime in 2012. With a brand new web interface, our new system positions DSM users for new regulatory changes such as 5010 and ICD10 while at the same time providing new clearinghouse and scrubbing services. In order to meet the ever increasing demands for claim information down to increasingly detailed levels, our programmers have taken the control structures down to the insurance company level (right) and insurance claim build profiles have been enhanced (below).
Menu structures are drop-down selections within the browser (right):
Using experience gained in working with other clearinghouse interfaces, the DSM solution will generate claims automatically, requiring little human intervention. If a claim does require maintenance for correction errors found in the scrubbing process, it will be corrected with screens in our new web interface. There are many great features and instead of trying to address each one, we will highlight certain features as we go along. For example, predictive text searches provide for fast lookups and more accurate input. The best way to explain predictive searches would be to demonstrate. For example, the following shows how our new programs do a city/state/zip lookup using predictive search:
On the left is the field for the patient’s city, state and zip. Of course, for insurance filing purposes, this field is mandatory and that condition is indicated by the red underlining of the field.
The user only has to begin keying the city, “spring” and the predictive matches appear in a box below the field:
As the user continues typing and gets to the state code for MS, the correct city, state and zip is displayed for the user to simply click and select.
Note that the user doesn’t have to type all of the city name. Typing “spring” and then putting a “,” and the first character of the state code, provides a list of cities to choose from in alphabetical order in states that begin with the letter “M”. Predictive text reduces keying and improves accuracy.
This first installment article on our new insurance system is just a glimpse. Look for future emails or just check this blog for more in-depth articles on the clearinghouse, claim scrubbing, certification and “deep dives” into the new system which will be available late September to early October.