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!