Eligibility & Claims Inquiries: Connecting Your Revenue Cycle

Real-Time Eligibility and Benefit InquiriesOptimumSeries Eligibility and Clearinghouse services module offers Real-Time Eligibility and Benefits Lookups, simplifying your workflow by connecting directly to Payors to verify patient eligibility before admitting or rendering services. ADL User Interface functions connect to the largest health information networks (HIN or RHIO) in the nation, enabling access to insurance coverage directly from the Payors.

Eligibility lookups instantly display the information and the data can be automatically inserted into the patient ADT record. Now you can instantly view a patient’s or prospect’s:

  • Insurance Plans
  • Insurance Coverage
  • Remaining Benefits

The functions are accessible with web-based programs and/or from the ADL User Interface (GUI). Displayed information can printed or imported as needed.

Electronically Submit Claims

OptimumSeries simplifies your insurance claim processing by uploading them to the Clearinghouses, directly from your Billing module. Submitting Medicare, Medicaid, HMO or Workman’s Compensation medical claims is quick and easy. Reach 1,200+ payers to electronically Invoice (with Attachments) to comply with applicable state and Payor mandates.

View/Edit Medicare Claim Submissions

Access or view your submitted claims to CMS Medicare. The system provides the ability to edit claims directly on the Medicare Direct Data Edit (DDE) part of the Fiscal Intermediary Standard System. Now small edit problems with the bills can be quickly corrected to expedite the claims processing. Eliminate Claims being held due to small user edit issues. Your user interface is supported via a 24 X 7 Help desk.

Your Claims can be submitted through the Clearinghouse eliminating the need for multiple submissions to different Payors. Providers have achieved a Clean Claims Rates approaching 99%.

Electronic Remittance Advice (ERA)

Payments are transmitted to your system as Electronic Remittance Advises. The Advises are imported directly into the system and can be posted to the Patients Accounts Receivable. Automating your ERAs improves your cash flow and will save you time. Utilize your resources more effectively by electronically posting payments. States implementing Managed Medicaid are supported through the clearinghouse.

Assistance With Payor Enrollment

ADL has added Eligibility and Clearinghouse services to the patient accounting modules. The Eligibility Lookups have been fully integrated with the ADL software and is fully supported by our Subject matter Experts (SMEs).

Assistance will be provided enrolling your facility with Payors and Insurance companies that need to be accessed. Once enrolled, you will have access to the online lookup and claims management functions directly from your ADL software or from your web browser.

Feature  Availability
Unlimited Electronic Claims
Unlimited Electronic Remittances
Dedicated Support Representatives
Front-End Editing for Improved Carrier Acceptance
Automated Secondaries
Real-Time Eligibility
Real-Time Claim Status
24×7 Access*
Paper and Electronic Patient Statements
Online Payment Portal
Paper Claims
Advanced Reporting
Multi-browser Accessible
Payer Alerts

  • Control Submitted Claims
  • Easy Implementation
  • Higher Claim Approval Rate
  • Revenue Cycle Management
  • Reduce Rejection Rates
  • Saves Time & Reduces Errors
  • Access Medicare
  • Access Payor EDI Systems
  • Monitor Submitted Claims
  • Online Payer Connectivity
Supported Devices
  • Smartphones
  • iPads & Android
  • PC Workstations
  • Payor Enrollment
  • Online 24 / 7 Support
  • “Go-Live” Monitoring
Integrated With
  • ADL User Interface