Efficiency
Identify incorrectly paid claims and assess the validity of an error in minutes. All the data you need for analysis is aggregated for each individual claim and just "click" away.

Analytic Functionality
ARS incorporates unique tools to aid in analysis and resolution:

The Process Trail describes how the payment was calculated for each claim

The Contract Summary defines the contractual terms for every claim processed

The Procedure Worksheet compares expected and actual payment & discount at the code level.

Provider contracts and related documents are available to analysts from within the claim

Code definitions are available at the click of a mouse

Analysts can manually override the “net expected payment” calculation

Audit Code assignment allows the user to define the reason for the payment error on each claim and easily perform comprehensive Root Cause analysis on the findings.

Flexibility
Chart-Tech’s contract load utility (ECMS) and the Repricer accommodate the most complex contract terms across the spectrum of ancillary, institutional and professional claims. Whatever your needs, our claim auditing technology will ensure that incorrectly paid claims are identified for appropriate action, with little or no manual intervention required.

Monitoring Ability
The Audit & Reporting System is more than a "snapshot" of the present. It’s a dynamic function – continually monitoring for payment integrity along the time continuum. New claims and payment data (including adjustments) are a continual process flow, so a claim paid correctly yesterday may be paid incorrectly today. That’s why you need our monitoring tool. As contracts are renewed, users create a new contract in minutes by copying the current contract into the new time frame and modifying the affected business rules.

Data Aggregation
ARS will allow your revenue recovery unit to dramatically enhance productivity, ROI and quality control. For each claim, users can view the original billing data; claims payment detail; the Process Trail which explains exactly how the "expected payment" was calculated; the Contract Summary which presents the specific contractual terms for that individual claim; and much more. Users can assign an "Audit Code" representing why the claim was mis-paid (for root cause analysis), enter explanatory comments, even “cut & paste” relevant language out of the contract into the comments field to support their conclusions.

Customization
As with all Visium™ solutions, ARS is completely customizable. Adding more data elements and functionality is easily accomplished.

Scalability
ARS is designed to function in all sizes of enterprises from the smallest to the largest health plans. It can be configured to run as a desktop application, or as a server-based implementation supporting thousands of concurrent users.