Encite Claim Editor

The Next Generation in Claims Editing and Scrubbing

Say goodbye to submitting claims that are repeatedly denied over many months … even when all published claim filing rules have been followed!

Encite's user-friendly, automated methodology solves the problem of first pass denials by capturing and cataloging the unpublished edits payors actual use in claims adjudication.

Encite's state of the art Claim Editor uses this payor information and its proprietary predictive technology to pinpoint every error in every claim before initial submission. The advantages are extraordinary. Imagine the benefit to your organization when claims are submitted quickly and easily submitted electronically and approved on initial presentation.

To date tens of millions of claims have been successfully scrubbed and submitted. Shouldn't you be using this effective tool, too?

Encite Transaction Services' Claims Editor eliminates denial of eligible claims with features that include:

• Millions of commercial and government payor edits - almost half unpublished
• Automatic updates every week
• Field-proven technology
• Automated electronic claims submission

Encite Transaction Services gives you the benefit of

• Accelerated cash flow
• Receivables reduction of up to 20%
• An AR days reduction of up to 20%
• Lower claims processing costs
• Improved organizational work processes through denial analysis
• Supported Edits:
  • All seven recommended WEDI/SNIP levels
  • Procedure coding to check age and gender restrictions as well as CCI policy compliance
  • Medical necessity using CPT/ICD9 crosswalk data and the ordering of procedures for maximum reimbursement
  • Diagnosis coding using valid primary diagnoses, proper levels of specificity and the inclusion and ordering of any required accompanying diagnoses
  • Situational/conditional fields and service/procedure related fields are checked to see if they are required and reported
  • Logical date-field relationships (e.g., date of onset on or before date of service)
  • Payor-specific published rules editing (Medicare, Medicaid, commercial carriers, etc.)
  • Unpublished payor-specific rules editing

The Encite Transaction Services System includes: