BETTER CLAIMS PROCESSING
IS BETTER BUSINESS

OUR SERVICES

Smart health care providers don’t underestimate the importance of accurate, efficient Medicaid claims processing. They enjoy quicker payments by reducing reimbursement times, and drive additional revenues by recovering unpaid claims. Combine this with improved staffing efficiencies and lower overhead costs and you have a better model for a more profitable business.

While electronic systems can reduce the time, effort, and potential for errors associated with paper-based processes, they can be just as complex and costly as the systems they replace. And questions of security – of the transactions and of your data – are always a concern.

What’s needed is a system that improves revenue cycle performance, conforms to your office workflows, and promises full regulatory compliance and best-in-class security. That system is available from CDS.

With the CDS solution, you’ll enjoy a much more efficient claims submission process:
• It’s completely automated, including eligibility checks
• We’ll prepare your data, no matter what form it’s in, for use in our system
• We’ll deliver information back to you in ways that you can actually use

Security is a paramount concern, and one of the hallmarks of the CDS solution:
• You access the system via fully secure HTTPS connections over TLS
• Advanced military-grade encryption techniques protect your data
• Regular risk assessments performed in accordance with HIPAA/HITECH rules
• Uploaded files are stored outside the addressable URL space of the server
• All data is securely backed up daily

We offer tools to help keep you fully abreast of submission and payment status:
• Claims and eligibility checks are submitted within minutes of client data upload
• Submissions are confirmed instantaneously via automated emails
• Client dashboard allows you to monitor the status of claim progress

Our custom data analytics give you access to unprecedented insights:
• Included reports provide detailed results within hours – not days or weeks
• Custom queries and reports answer specific questions about your accumulated data
• Now you can make better decisions, quickly and confidently

  • Medicaid Billing
    Efficient implementation of all Medicaid processes: determine eligibility and other insurance coverage, claim submission, claim status and remits.
  • HIPAA/HITECH risk assessments
  • Claim Status Reports
    Get payment and denial information immediately after claim submission instead of waiting weeks for the remit.
  • 835 Remittance Advice Processing
    Payments, denials, CARCs and RARCs interpreted, with both codes and English-language descriptions. Reports can be made to resemble the original paper remits, if desired.
  • Data Mining, Custom Queries & Analytics
    Experts in data integration and conversion, we can analyze your data to answer specific, detailed questions.

All of our transactions are compliant with EDI specifications (version 5010) published by the Accredited Standards Committee (ASC) X12. Here are the transactions we support:

  • 835 Electronic Remittance Advice
    Explanation of all claims processed by the payer’s adjudication system. Paid and denied claims are identified. Claims accepted into adjudication may still deny – if they do, claim adjustment reason codes (CARCs) are reported. CDS converts electronic remits into human readable Remit Reports – either PDF or spreadsheet.
  • 270 Eligibility, Coverage or Benefit Inquiry
    The 270 requests coverage information from the payer. We can generate an eligibility request transaction from your data in any format.
  • 271 Eligibility, Coverage or Benefit Response This is the payer’s response to the 270. Information from the 271 response is formatted to meet your needs. We can, for example, provide Eligibility Reports as Excel spreadsheets to simplify your sorting and searches.
  • 277CA Claim Acknowledgement
    This is a response to a submitted 837 claim. The 277CA acknowledges validity and acceptability of claims, ahead of the payer’s adjudication process. This check is performed so claims that are incorrectly formatted or missing information can be corrected and resubmitted. Denials at this stage are referred to as “front end edits”; details and recommended actions are included in the Claim Submission Report.
  • 276 / 277 Claim Status Request / Response
    The 276 is a request for claim status and the 277 is the payer’s response, which provides status of the claim in the payer’s adjudication process. This is useful to provide information additional to what is available in the 835, particularly for denials. All information is captured in the Claim Status Report.
  • 837 Health Care Claim
    We generate 5010-compliant Institutional and Professional claims from your proprietary data.

CDS SOLUTIONS IN THE CLOUD

The CDS solution is cloud-based and works through your web browser – no software to install, available 24/7, and always up to date.

Unlike other services, we tailor our solution to fit your workflow and process. We accept data in virtually any format and adapt it to work with our process.

There’s never been an easier way to manage medical claims processing. Best of all, every component of the system is secure, backed up, and fully compliant with all applicable regulations.

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