• Electronic Medical Records (EMR)
• Scheduler with Eligibility Test
• Compliance Management
  + Core Elements
  + Regulatory Risks
  + Auditing and Monitoring
  + Documentation Guidelines
  + Audit Exposure Evaluation
• Data Entry and Payment Posting
+ Charge Entry
• Superbill Interface
• Variety of Claim Entry Formats
• Fax
+ Demographic Data Entry

• Coding
  + Coding Consistency
  + Discovery of Undercoding
• Claim Submission to Payers
• Patient Invoicing
• Follow Up
  
+ Discovery of Underpayment

• Transparency, Analysis and Reporting
• Quality Control
  + Billing Process
  • Payment Distributions
  • Days in A/R
  + Claim Validation
  + Patient Eligibility Testing
  
• Data Center
  

Vericle® tests patient eligibility for the payment by the payer in real-time and in batch modes. This process identifies insurance coverage lapses, claims sent to wrong insurance companies, missing information, and incorrect patient id numbers.

Eligibility testing is run on all claims for a participating payer, typically at the point of patient scheduling, pre-service.

Comprehensive audit log details all tests run on each claim.

VERICLE AUTOMATICALLY TESTS MEDICAL CLAIM ELIGIBILITY FOR THE FOLLOWING PAYERS:

AETNA
ALABAMA MEDICAID
ARKANSAS MEDICAID
BLUE CROSS AND BLUE SHIELD MISSISSIPPI
BLUE CROSS AND BLUE SHIELD OF GEORGIA (ATLANTA) - AKA - STATE MERIT
BLUE CROSS AND BLUE SHIELD OF GEORGIA (COLUMBUS)
BLUE CROSS AND BLUE SHIELD OF GEORGIA STATE MERIT
BLUE CROSS AND BLUE SHIELD OF LOUISIANA
BLUE CROSS AND BLUE SHIELD OF MASSACHUSETTS
BLUE CROSS OF CA/PPO
BLUE CROSS OF CALIFORNIA
CIGNA
CIGNA - AKA - DME REGION D (DMERC D)
CIGNA BEHAVIORAL HEALTH
COLORADO MEDICAID
COMMUNITY HEALTH PLAN - MILWAUKEE, WI
CONNECTICUT MEDICAID
COVENTRY HEALTH CARE OF DELAWARE, INC.
COVENTRY HEALTH CARE OF GEORGIA, INC.
COVENTRY HEALTH CARE OF INDIANA, INC.
COVENTRY HEALTH CARE OF IOWA, INC.
COVENTRY HEALTH CARE OF KANSAS, INC. - KANSAS CITY
COVENTRY HEALTH CARE OF KANSAS, INC. - WICHITA
COVENTRY HEALTH CARE OF LOUISIANA, INC.
COVENTRY HEALTH CARE OF NEBRASKA, INC.
COVENTRY HEALTH CARE OF THE CAROLINAS, INC.
EDS - MEDI-CAL
EMPIRE BLUE CROSS AND BLUE SHIELD
EMPIRE BLUE CROSS AND BLUE SHIELD OF NEW YORK
EQUITABLE (CIGNA)
FLORIDA MEDICAID
GEORGIA MEDICAID
HARVARD PILGRIM HEALTH CARE
HEALTHSOURCE PROVIDENT (CIGNA)
HEALTHSOURCE, AR (MED) (CIGNA)
HEALTHSOURCE, GA (CIGNA)
HEALTHSOURCE, N. TX (CIGNA)
HEALTHSOURCE, NC (CIGNA)
HEALTHSOURCE, TN (CIGNA)
HORIZON BLUE CROSS BLUE SHIELD OF NEW JERSEY (HORIZON BCBSNJ) - AKA - BLUE CARD
CLAIMS (ITS, OUT OF STATE BS SUBSCRIBERS)
HUMANA
IDAHO MEDICAID
ILLINOIS MEDICAID
INDIANA MEDICAID
IOWA MEDICAID
KANSAS MEDICAID
KENTUCKY MEDICAID
LOUISIANA MEDICAID (ADULT DENTAL)
LOUISIANA MEDICAID (EPSDT)
MASSACHUSETTS MEDICAID
MINNESOTA MEDICAID
MISSISSIPPI MEDICAID
MISSOURI MEDICAID
NATIONWIDE HEALTH PLANS (HMO, PPO, POS)
NEW HAMPSHIRE MEDICAID
NEW JERSEY MEDICAID
NEW YORK MEDICAID
NORTH CAROLINA MEDICAID
OHIO HEALTH CHOICE
OHIO MEDICAID
OKLAHOMA MEDICAID
OREGON MEDICAID
OXFORD HEALTH PLANS
PACIFICARE OF CALIFORNIA
PACIFICARE OF OREGON
PACIFICARE OF TEXAS
PACIFICARE OF WASHINGTON
PENNSYLVANIA MEDICAID
PRUDENTIAL
TEXAS MEDICAID
TRICARE PALMETTO
VERMONT MEDICAID
VIVRA - CIGNA PLANS
WASHINGTON MEDICAID
WEST VIRGINIA MEDICAID
WISCONSIN MEDICAID
WYOMING MEDICAI