Winsoft Solutions L.L.C

Transcription

1 Winsoft Solutions L.L.C Do i.t professionally Standard Edits (AR,CMS, AMA, etc.) Add-Vantage Auto (e)claim Adapter Medical Edits Rules Engine DHA & HAAD compliant (+971)

2 Add-Vantage -Medical Edits Rules Engine Standard Edits (AR,CMS, AMA, etc.) Supported databases: Oracle, MS SQL Server, DB2 etc.. API & Web Services Highlighted Features Automatic upload / download for your e-claims and approval requests Integrated with Add-Vantage medical edits rules engine which DHA and HAAD complaint, based on the standard edits of (AR,CMS, AMA, etc.) Automatic Update User interface to validate before upload and download ( if needed) SDK available

3 Auto e-claim DHA & HAAD complaint Auto e-claim Adapter Claim Submission Remittance Advise Claim resubmission DHA & HAAD complaint

4 ALFMS -Features Standard Edits (AR,CMS, AMA, etc.) What Add-Vantage can add to you? - Validate your claims before submission to DHA and HAAD to avoid rejections - Validate your claims after downloading it from the payers or insurance companies - Get alerts of your claim status with the payers! (downloaded, processed, paid, rejected, and more) - Mapping between ICD9CM and ICD10CM - Mapping between your internal codes and the standard codes (ICDs, CPTs, HCPCS, CDT, ASL, DSL, etc ) - Validate agreed price list and mandatory tariff (if applicable) - Automate the process, to run dynamically without any human interfere - Get the edits Add-Vantage edits rules engine implemented which is equivalent to CEED and more.. - Cross-Walk, CPTs X ICDs - Medical necessity and edits and alerts - Interactions - Easy to manage - Pay as you go with more control - Auto/ SMS and notifications with API for your system

5 AV ICD 9 -ICD10 (CM) cross walks CPTs Winsoft Add-Vantage enables checking and alerting on potential mistakes and reviews in medical coding. Medical Necessity/Cross Coding Checks ICD CPT, ICD HCPCS, ICD CDT Coding Checks Bundling, mutually exclusive coding, duplications, maximum allowed frequencies, services relationship errors, encounter related edits. E-Claim Edits in Dubai covers: Diagnosis Codes (ICD-10-CM) Procedure Codes (CPT) Dental Codes (CDT) Dubai Service List (DSL) E-Claim Edits in Abu Dhabi covers: Diagnosis Codes (ICD-9-CM) Procedure Codes (CPT) Dental Codes (CDT) in 2014 Abu Dhabi Service List (ASL)

6 AV -ICD-10-AM/ACHI/ACS (AR) Winsoft Add-Vantage enables checking and alerting on potential mistakes and reviews in medical coding. Medical Necessity/Cross Coding Checks V8 and before ICD CPT, ICD HCPCS, ICD CDT (First-Eighth Edition) Coding Checks Bundling, mutually exclusive coding, duplications, maximum allowed frequencies, services relationship errors, encounter related edits. E-Claim Edits in 10 Versions and before covers: Diagnosis Codes (ICD-10) Australian Classification of Health Interventions (ACHI) Dental Codes (CDT) in 2014 Australian Coding Standards (ACS ) E-Claim Edits in 9 Versions and before covers: Diagnosis Codes (ICD-9) Australian Classification of Health Interventions (ACHI) Dental Codes (CDT) in 2014 Australian Coding Standards (ACS )

7 AV Codes Mapping Winsoft Add-Vantage has the mapping between all ICD9CM and ICD10CM and ICD9-AM and ICD10-AM and CPT to ACHI and ACS. Medical Necessity/Cross Coding Checks V8 and before ICD,ACHI,ACS,ICD,CPT,HCPCS, ICD,CDT Coding Checks Bundling, mutually exclusive coding, duplications, maximum allowed frequencies, services relationship errors, encounter related edits. E-Claim Edits in 10 ICD AM V 1 to 8: Diagnosis Codes (ICD-10) Australian Classification of Health Interventions (ACHI) Australian Coding Standards (ACS ) Dental Codes (CDT) in 2014 E-Claim Edits ICD CM 9 and 10 Versions: Diagnosis Codes (ICD-CM) Procedure Codes (CPT) Dental Codes (CDT) Dubai Service List (DSL)

8 Integrated with / Add-Vantage edits and CEED edits as follow: Add-Vantage is totally independent and is based on guidelines from recognized bodies such as CMS, AMA, ADA, local authorities, and other recognized societies. Medical Necessity/Cross Coding Checks - ICD-10-AM/ACHI/ACS (AR) Medical Necessity/Cross Coding Checks - ICD-10-CM/CPT/HCPCS, DSL and LONICS Coding Alerts CPT pairs checks, multi use alert Standard Edits (AR,CMS, AMA, etc.) Australian Edits Cover E-Claim Edits in Dubai covers E-Claim Edits in Abu Dhabi covers Update and Manipulate the standard codes

9 Add-Vantage Implementation Options Standard Edits (AR,CMS, AMA, etc.) Validate your claims before submitting to DHA and HAAD Database Access / License Automate the claims upload and download without human interfare Secure your claims from rejections from payers Choose your comfort option and request a demo Get a quote

10 How Can Winsoft Solutions Help? Improving distribution management with collaborative customer knowledge OPERATIONAL EFFICIENCY CUSTOMER EXPERIENCE DISTRIBUTION MANAGEMENT

11 Winsoft Solutions Contact us For further information please contact us U.A.E. Dubai +971 (4)