Claims Management (CM)

Why CM?

Today, payments mailed to healthcare facilities come in many different and confusing formats. To make matters worse, 50% of healthcare claims are short paid, not paid pending additional documentation, or completely denied. This has proven to be a huge burden for doctors and hospitals, adding to the time and cost associated with their claims management and losses in revenue from human error. It is not uncommon to see stacks of paper EOB’s piled on the desk, with no means of effective near term resolution or oversight. 

TVM’s CM service will image capture each EOB, provide the user with an electronic image file, and then generate a standard report form with which to view all claims in need of review and resolution. Included in the reporting is:

• a user based rules set providing review by exception
• staff targeted resolution accountability
• resolution target date
• action taken
• final outcome
• objective report file

Together, this combination of features will present only those claim’s issues that:

• need action
• indicate who is responsible for action
• type of action needed
• date action should be accomplished
• final outcome of the action taken

The reports can be viewed from any perspective and will provide an accounting of each insurance payer as regards their habits in claims handling and settlement.

An optional service to the above is the automatic payment processing that will be performed by TVM, and its partnering banks. Doctors and hospitals can elect to have all insurance payments sent directly to the TVM partnering bank (this is in contrast to AR management where only patients send checks to the TVM lock box). The bank would deposit the checks directly to the user’s account and direct the images to TVM’s document center. Deposits could automatically be credited to each patient’s account. This service would eliminate all posting activities at the healthcare facility, with the exception of over-the-counter payments, and minimize the risk of human errors and employee embezzlement.

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