A healthcare technical partner supporting claims activities end to end
Revenue Cycle management (RCM) is the financial process between healthcare providers and insurance payers, where utilizing the right RCM technical tool and process that facilitates to process the claims activities more efficiently and effectively.
RCM system provide a platform to bring together business and clinical side of healthcare administrative data such as patient data, clinical data, insurance data, and claims data till collecting the payment. And Cephal RCM system track claims throughout their lifecycles, these technologies facilitate a steady stream of revenue.
Establishing timely communication with health insurance payers is very vital in effective RCM.
Our RCM System modules are:
Insurance Eligibility checks
Insurance contact management
Medical coding tool
Medical code auditing tool
Claims pre-submission audit based on healthcare payer payment behavior
Electronic claims submission
Insurance settlement electronic update
Claims dashboard and reports
Claims Document Management
Cephal RCM system equip healthcare providers to manage their RCM process more efficiently,
We offer RCM system as:
Integrated application with Hospital Information System
Data Clearing House
Cephal Healthcare Data Clearinghouse provide the ability to take in non-standard data and process it into standard data formats that can be ingested into any pertained regulatory bodies, insurance payers, healthcare Analytical tools…etc.
Cephal Data cleansing or data cleaning is to detect and correct corrupted or inaccurate records from patient record set, table, or database and refers to identifying incomplete, incorrect, inaccurate or irrelevant parts of the data and then replacing, modifying, or deleting the dirty or coarse data.
Revenue Cycle Management - Operation
Along with RCM system, equally important to have an experienced medical coders and other supporting RCM operational resources for effective RCM outcome.
Pharmacy Benefit Management
Cephal Pharmacy Benefit Management is an automated Clinical Screening Solution, using technology to support clinicians with making better informed medication-related decisions. It is designed to alert clinicians and pharmacists making prescribing decisions to information about avoidable medication errors, inappropriate dosing and adverse events.
Claims Audit - Patient Record Audit
Group of trained RCM professionals (internal or outsourced) who are involved with the patient from the start of their care to the very end when payment is made. They assign appropriate codes based on a patient's record and bill. These codes are made into Pre-approval & claims that are sent to the patient's insurance company/TPA.
Claims Analytics - Medical Data Analytics
For Healthcare providers, revenue cycle management is an integral - but complicated component of ensuring an organization runs efficiently and effectively.
Medical coding and Audit Tool
Medical coding can be incredibly laborious to assign medical codes. The complexity of the medical coding process has increased due to the latest healthcare reforms. There is demand for perfect documentation and its coding. Anything less than perfect, means, rejected claims, or, worse still, fines for miscoding.