{"id":917,"date":"2014-03-31T21:25:34","date_gmt":"2014-03-31T21:25:34","guid":{"rendered":"http:\/\/bitincsystems.com\/?p=917"},"modified":"2018-09-27T22:12:38","modified_gmt":"2018-09-27T22:12:38","slug":"claims-workbench","status":"publish","type":"page","link":"https:\/\/www.bitincsystems.com\/?page_id=917","title":{"rendered":"Claims WorkBench"},"content":{"rendered":"<h2><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-906 alignright\" src=\"https:\/\/bitincsystems.com\/wp-content\/uploads\/2013\/09\/Claims-WorkBench-Modified-231x300.gif\" alt=\"Claims WorkBench\" width=\"231\" height=\"300\" \/><em><span style=\"color: #00a950;\">Product Summary<\/span><\/em><\/h2>\n<p>The <strong>Claims Workbench&#x2122;<\/strong> system allows you to search for claims by patient name, provider account number, or submitted member ID.<\/p>\n<ul>\n<li>Automatically identify claims that need <strong>manual review<\/strong><\/li>\n<li>Add <strong>your own unique<\/strong> queues<\/li>\n<li><strong>Continue auto processing<\/strong> after manual decision points<\/li>\n<li><strong> Identify data inconsistent<\/strong> with your claims management system\u2019s data<\/li>\n<li>Send <strong>only clean claims<\/strong> to your claims management system<\/li>\n<li><strong>Write your own reports<\/strong> with VB, etc., using our license COM library<\/li>\n<\/ul>\n<p><a href=\"https:\/\/bitincsystems.com\/wp-content\/uploads\/2014\/04\/BitInc-Green-Line.jpg\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/bitincsystems.com\/wp-content\/uploads\/2014\/04\/BitInc-Green-Line-300x5.jpg\" alt=\"BitInc Green Line\" width=\"877\" height=\"7\" \/><\/a><\/p>\n<p>The<strong> Claims Workbench&#x2122;<\/strong>  system makes 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 on-line and printed to paper.  There are no questions about what was submitted, because you have permanent <strong>storage of unaltered claim data.<\/strong><\/p>\n<p>Our <strong>Claims WorkBench&#x2122;<\/strong> system is <strong>powered by<\/strong> our <strong>DaFoDiL&#x2122;<\/strong>  data format description language.  You can store <strong>any<\/strong> file whether submitted in form, record, or X12 formats.  Examples of such formats include CMS1500 and UB04 print formats, NSF record formats, HIPAA 837 X12 formats, and proprietary formats such as UNILAB Tab Delimited or your provider\u2019s favorite Excel spreadsheet.<\/p>\n<p>The <strong>Claims WorkBench&#x2122;<\/strong>  system uses Smart Naming to identify the format of the claims file so that the DaFoDiL<strong>&#x2122;<\/strong> engine can control the inload.<\/p>\n<p>With the <strong>Claims WorkBench&#x2122;<\/strong> system, the user is able 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.  The system can automatically reject the file if these totals do not match the claim file.<\/p>\n<p><em><span style=\"color: #00a950;\"><a href=\"https:\/\/bitincsystems.com\/wp-content\/uploads\/2014\/04\/BitInc-Green-Line.jpg\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/bitincsystems.com\/wp-content\/uploads\/2014\/04\/BitInc-Green-Line-300x5.jpg\" alt=\"BitInc Green Line\" width=\"877\" height=\"7\" \/><\/a> <\/span><\/em><\/p>\n<p>The <strong>CWB-Router&#x2122;<\/strong>  work flow system provides a means of directing claims into multiple queues and identifying claims that need to be reviewed manually.  Initial queues in this <strong>claims work flow manager<\/strong> can be determined by a series of business rules.  Some of the queues can require manual claim review to determine the final queue.<\/p>\n<p>Business rules can determine the queue of a claim based on eligibility information.  The system can also run business rules using data from your claims management system that identify rejections for invalid codes, manual holds for eligibility review and manual holds for updating the claims management system\u2019s tables, e.g., provider tables.<\/p>\n<p>Standard business rules include: eligibility verification, validation for service codes, revenue codes, diagnosis codes, procedure codes and modifier codes, and translation table checking.<\/p>\n<p>In addition, <strong>business rules specific to your needs<\/strong> can also be included.  For example, current clients are reviewing claims exceeding a certain dollar amount, reviewing claims containing specific service or diagnosis codes, and reviewing claims for inconsistent financial classes.<\/p>\n<p>The <strong>CWB-Router&#x2122;<\/strong> work flow system provides the following benefits:<a href=\"https:\/\/bitincsystems.com\/wp-content\/uploads\/2014\/09\/DaFoDiL-Logo.TM_.gif\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-1446 size-medium alignright\" src=\"https:\/\/bitincsystems.com\/wp-content\/uploads\/2014\/09\/DaFoDiL-Logo.TM_-125x300.gif\" alt=\"\" width=\"125\" height=\"300\" \/><\/a><\/p>\n<ul>\n<li>Automatically identify claims that need <strong>manual review<\/strong><\/li>\n<li>Send <strong>AB1455 Status Report or 227CA<\/strong> to providers immediately after file receipt<\/li>\n<li>Add <strong>your own unique<\/strong> queues<\/li>\n<li>You <strong>control the hold\/manual-intervention<\/strong> queues<\/li>\n<li><strong>Continue Autoprocessing<\/strong> after manual decision points<\/li>\n<li>Audit Reports identify who has manually changed queues<\/li>\n<li>Hold claims for <strong>invalid provider numbers<\/strong><\/li>\n<li>Automatically direct claims to <strong>third parties<\/strong><\/li>\n<li><strong>Identify data inconsistent<\/strong> with your claims management system\u2019s data<\/li>\n<li>Send <strong>only clean claims<\/strong> to your claims management system<\/li>\n<li><strong>Write your own reports<\/strong> with VB, etc. using our license library<\/li>\n<li>Identify claims with <strong>negative charges<\/strong><\/li>\n<li>Claim queues identify <strong>operational responsibility<\/strong> for review<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Product Summary The Claims Workbench&#x2122; system allows you to search for claims by patient name, provider account number, or submitted member ID. Automatically identify claims that need manual review Add your own unique queues Continue auto processing after manual decision points Identify data inconsistent with your claims management system\u2019s data Send only clean claims to&#8230; <a class=\"moretag\" href=\"https:\/\/www.bitincsystems.com\/?page_id=917\">Continue reading &raquo;<\/a><\/p>\n","protected":false},"author":3,"featured_media":0,"parent":909,"menu_order":1,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-917","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/www.bitincsystems.com\/index.php?rest_route=\/wp\/v2\/pages\/917","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.bitincsystems.com\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.bitincsystems.com\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.bitincsystems.com\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/www.bitincsystems.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=917"}],"version-history":[{"count":5,"href":"https:\/\/www.bitincsystems.com\/index.php?rest_route=\/wp\/v2\/pages\/917\/revisions"}],"predecessor-version":[{"id":1601,"href":"https:\/\/www.bitincsystems.com\/index.php?rest_route=\/wp\/v2\/pages\/917\/revisions\/1601"}],"up":[{"embeddable":true,"href":"https:\/\/www.bitincsystems.com\/index.php?rest_route=\/wp\/v2\/pages\/909"}],"wp:attachment":[{"href":"https:\/\/www.bitincsystems.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=917"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}