Claims Workbench™
Integrated storage and retrieval of electronic claims files in original formats
Download
information on Claims Workbench in PDF format
CWB Router™
A Claims Work Bench Add-In that directs claims to destinations that you determine
using custom designed algorithms, e.g., eligibility review, rejected because
of bad data
Download
information on CWB Router in PDF format
AutoLoader
Automatically loads claims into the Claims Workbench
Claims Workbench™ provides a permanent,
searchable copy of all electronic claims submitted to you. You may search
by patient name, provider account number or submitted member ID. Claims can
be viewed in their original format, either on-line or on paper. There are
no questions about what was in the file, because you have a permanent copy
of the data.
Claims Workbench™ is powered by DaFoDiL® our data format description language. You can store any electronically submitted file whether submitted in print format, record format or X12 format. Examples of such formats include HCFA1500 and UB92 print formats, NSF record formats, HIPAA 837 X12 formats, and proprietary formats such as UNILAB Tab Delimited or your provider's favorite Excel spreadsheet.
Claims Workbench™ uses Smart Naming to identify the format of the claims file so that DaFoDiL® can control the inload.
Claims Workbench™ allows the user to set client specific rejection criteria for claims inload. For example, providers can submit secondary files that contain the number of submitted claims and dollar totals. Claims Workbench™ can automatically reject the file if these totals do not match the claim file.
For enhanced functionality, consider the following Add-In options:
Claims Workbench™ has an Autoload Add-In which allows the system to load claim files while you sleep. This means that claim files may be deposited in a specific directory and automatically loaded into Claims Workbench™.
Claims Workbench™ has a Router Add-In which allows submitted claim files to be analyzed and submitted to various destinations.
Back to Top
CWB Router™ is an Add-In to the Claims Workbench™ which provides a means of directing files from a claim file to multiple destinations and identifying claims that need to be reviewed manually. Initial destinations can be determined by a series of Router Algorithms. Some of the destinations can require manual claim review to determine the final destination.
For the EZ-CAP® managed care system customers with multiple databases/companies, an algorithm can determine which database/company the claim should be destined for based on the EZ-CAP® managed care system eligibility information. The Router can run algorithms that identify resubmits for invalid codes, manual holds for eligibility review and manual holds for updating the EZ-CAP® managed care system tables, e.g., provider tables.
CWB-Router™ provides the following benefits:
- Automatically Identify Claims that need manual review
- Add your own destinations
- You control the hold/manual-intervention destinations
- Continue Autoprocessing after manual decision points
- Audit reports identify who has manually changed destinations
- Hold claims for invalid provider numbers
- Print claims with negative charges
- Automatically direct claims to third parties
- Identify data inconsistent with the EZ-CAP® managed care system Data
- Send only clean claims to Claims-2-Ezcap™
Here are some algorithms that can be installed with the Router--or we can custom-design your own.
- Member Eligibility Checking against your Claims Management system, e.g., the EZ-CAP® managed care system
- Valid Provider Check including translated values
- Valid Revenue/Procedure Code Check
- Valid Diagnosis Code
- Valid Mod Code Check
- Negative Balance Check
- Batch Balancing Check for number of claims and total batch amount
- Financial Class Validation for Hospital Claims
The AutoLoader allows you to automatically load claims into Claims Workbench.
Just have them deposited into the directory that you designate, and let the
AutoLoader do the work.
Back to Top