For Dbtech customers Ras provides features well beyond traditional EDM. For example, many of our customers have recognized the efficiency of automating payer notification through the Ras Notice of Admission (NOA) workflow and have mitigated the potential for lost revenue and reclaimed hours of personnel time. Provider to payer notifications are routinely used to verify benefits, link members to other programs, and assess the need for case management. Healthcare providers must notify the insurance providers for :
- Acute inpatient admissions
- Inpatient hospice
- Skilled nursing facility and acute rehabilitation admissions
- Behavioral health and chemical dependency
- Residential treatment centers and intensive outpatient treatment centers
The need for NOA is based in the hospital requirement to notify payers of unscheduled patients within 24 hours. This is a process prevalent with ER and unscheduled maternity patients. It is the hospital’s responsibility, either through a fax, interface transaction, phone call or data entry into a web-based application, to transmit the necessary data elements to the payer, and is distinct from the process of obtaining medical necessity. You may believe these transactions are occurring through normal EDI routes, but many payers expect these documents to be delivered via fax.
Problems typically occur over off-hours and the weekend, where staff can “forget” to transmit notifications because of its manual nature. Many times when regular staff arrive they discover patients that should have been transmitted, but have not. This is especially critical when the registration occurs over the weekend.
The Ras NOA workflow solves this problem, and acts as a 24/7 messenger between the provider hospital and the patient’s insurance company. At the moment of registration, Ras NOA collects patient data through various methods (print-output, HL7 etc.), and determines if the encounter requires notification. Documents are transferred to the payer, hospital staff have insight into all steps, and have methods to re-queue transactions as needed.
This workflow is important, as non-compliance is costly and manual adherence time consuming. In one customer example a claim for $86,000 was reduced by $24,000 because of failure to notify the payer. When this process is left to manual workflows, users can expect to spend more than 15 minutes per registration to obtain the appropriate data, record that data on pre-designed forms and fax that data to the proper payer. If the insurer’s fax-in line is busy the user has to try again. This manual workflow is fraught with potential errors and inefficiencies.
Ras is the Swiss Army Knife of EDM workflows, and can be your access point for any document, data or workflow for internal users and outside interests, including payers and secondary providers.